Individual provider Active NPI

Angela Diane Patti

  • Gerontology Nurse Practitioner
  • Munster, IN
National Provider Identifier
1255848263
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71007769A Issued in IN
Practice address
9104 Columbia Ave
Munster, IN 46321-2907
Phone
(219) 836-4473
NPI assigned
Dec 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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 28177745A IN
Primary Care Nurse Practitioner 363LP2300X 71007769A IN
Gerontology Nurse Practitioner 363LG0600X 71007769A IN Primary

Addresses

Primary practice location

9104 Columbia Ave
Munster, IN 46321-2907

Mailing address

12754 Connecticut St
Crown Point, IN 46307-7573
Phone (773) 738-2522

Other practice location 1

9034 Columbia Ave
Munster, IN 46321-2905
Phone (219) 836-4473

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180315001773 IN Practitioner - Nurse Practitioner 9739441502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

10215 Broadway
Crown Point, IN 46307-8001

1400 S Lake Park Ave
Hobart, IN 46342-6791

901 Macarthur Blvd
Munster, IN 46321-2901
Phone (219) 836-4563

9104 Columbia Ave
Munster, IN 46321-2907
Phone (219) 836-4473

9120 Columbia Ave
Munster, IN 46321-2907
Phone (219) 703-5301

9122 Columbia Ave
Munster, IN 46321-2907
Phone (219) 836-3366

9124 A Columbia Ave
Munster, IN 46321-2907
Phone (219) 440-7025

9124 Columbia Ave
Suite B
Munster, IN 46321-2907
Phone (219) 836-0445

9126 Columbia Ave
Munster, IN 46321-2907
Phone (219) 703-2408

9130 Columbia Ave
Munster, IN 46321-2932

Hospital & facility affiliations

  • Community Hospital Hospital, Munster, IN, CCN 150125
  • St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034
  • St Catherine Hospital Inc Hospital, East Chicago, IN, CCN 150008
  • Powers Health Rehabilitation Center Inpatient rehabilitation facility, Crown Point, IN, CCN 153045

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28177745AINMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc CurrentSince Feb 10, 2018 Accepting new patients

Locations

4320 Fir St
Unit 320
East Chicago, IN 46312
Phone (219) 392-7992

1400 S Lake Park Ave
Ste 300
Hobart, IN 46342
Phone (219) 942-1169

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

9120 Columbia Ave
Munster, IN 46321
Phone (219) 513-9415

9034 Columbia Ave
Munster, IN 46321
Phone 219836019336201

9104 Columbia Ave
Munster, IN 46321
Phone (219) 836-4473

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

Interoperability endpoints

  • Direct secure messaging: apatti10002@ssdirect.comhs.org

Organizations & group practices 1

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1255848263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12754 CONNECTICUT ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077573",
            "telephone_number": "773-738-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9104 COLUMBIA AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212907",
            "telephone_number": "219-836-4473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9034 Columbia Ave",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463212905",
            "country_code": "US",
            "telephone_number": "219-836-4473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATTI",
        "first_name": "ANGELA",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-29",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28177745A",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IN",
            "license": "71007769A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71007769A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.