Individual provider Active NPI

Jennifer Thomason, NP-C

  • Family Nurse Practitioner
  • Valparaiso, IN
National Provider Identifier
1255099263
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71013308A Issued in IN
Practice address
649 N 200 E
Valparaiso, IN 46383-9711
Phone
(219) 728-8223
NPI assigned
Dec 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041401225 IL
Family Nurse Practitioner 363LF0000X 209024505 IL
Family Nurse Practitioner 363LF0000X 71013308A IN Primary

Addresses

Primary practice location

649 N 200 E
Valparaiso, IN 46383-9711

Mailing address

649 N 200 E
Valparaiso, IN 46383-9711
Phone (219) 728-8223

Other practice location 1

12251 S 80th Ave
Palos Heights, IL 60463-1290
Phone (708) 923-4000

Other identifiers 1

IdentifierTypeStateIssuer
041401225OtherILRPN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220517000405 IL Practitioner - Nurse Practitioner 7214314079 Reassigns benefits to 1 organization
I20221222001564 IN Practitioner - Nurse Practitioner 7214314079 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Practice addresses (Care Compare)

1320 W State Rd
Suite 2
La Porte, IN 46350-4666
Phone (219) 727-6431

4152 W State Rd
Suite 56
Hanover, IN 47243-9070
Phone (901) 351-1791

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041401225ILMDRegistered Nurse
209024505ILMDFamily Nurse Practitioner
71013308AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Jan 4, 2025 Accepting new patients
FC Indiana, LLC CurrentSince Jan 19, 2025 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Jan 4, 2025 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Feb 25, 2022 Accepting new patients
FC Indiana, LLC CurrentSince Jan 19, 2025 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Feb 25, 2022 Accepting new patients

Locations

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

2418 16th St
Bedford, IN 47421
Phone (812) 278-3154

4152 W State Road 56
Hanover, IN 47243
Phone (812) 762-4510

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1255099263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "649 N 200 E",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463839711",
            "telephone_number": "219-728-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 N 200 E",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463839711",
            "telephone_number": "219-728-8223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12251 S 80th Ave",
            "address_purpose": "LOCATION",
            "city": "Palos Heights",
            "state": "IL",
            "postal_code": "604631290",
            "country_code": "US",
            "telephone_number": "708-923-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMASON",
        "first_name": "JENNIFER",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-07",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041401225",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209024505",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71013308A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RPN LICENSE",
            "identifier": "041401225",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

Verify at the official NPI Registry.