Chavonn L Dedeaux, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F03240103 Issued in IN

Practice address

5495 Broadway
Merrillville, IN 46410-1647

Phone

(219) 884-4900

NPI assigned

Aug 4, 2015

Last updated

Mar 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Chavonn L Dedeaux Professional name

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edgewater Systems for Balanced Living IncGroup PAC ID 9234398397, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Hospitals Inc Hospital, Gary, IN, CCN 150002

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: chavonn.dedeaux.p1@direct.edgewater.nextgenshare.com

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

• Edgewater Systems for Balanced Living, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gary, IN
  • NPI 1588705784
  Medicare reassignment Care Compare group NPD
• Edgewater Systems for Balanced Living, Inc

  • Federally Qualified Health Center (FQHC)
  • Gary, IN
  • NPI 1093670648
  NPD
• Edgewater Systems for Balanced Living, Inc

  dba Edgewater Health - Turning Point

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gary, IN
  • NPI 1568955037
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Methodist Hospitals, Inc

  • General Acute Care Hospital
  • Gary, IN
  • NPI 1467504555
  Care Compare affiliation

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1255717096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4187 JEFFERSON ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464082833",
            "telephone_number": "708-271-3973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5495 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464101647",
            "telephone_number": "219-884-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3535 Broadway",
            "address_purpose": "LOCATION",
            "city": "Gary",
            "state": "IN",
            "postal_code": "464091316",
            "country_code": "US",
            "telephone_number": "219-884-4900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4747 W 24th Ave",
            "address_purpose": "LOCATION",
            "city": "Gary",
            "state": "IN",
            "postal_code": "464062821",
            "country_code": "US",
            "telephone_number": "219-885-4264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 W 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Gary",
            "state": "IN",
            "postal_code": "464021711",
            "country_code": "US",
            "telephone_number": "219-885-4264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEDEAUX",
        "first_name": "CHAVONN",
        "middle_name": "L",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-04",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "F03240103",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28246104A",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IN",
            "license": "27071592A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHAVONN",
            "last_name": "DEDEAUX",
            "middle_name": "L",
            "credential": "FNP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Family Nurse Practitioner in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.