Jenna L Shock, MSN, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71009466A Issued in IN

Practice address

1690 Broadway
Building 19, Suite 10
Fort Wayne, IN 46802-2012

Phone

(260) 200-4940

Fax

(949) 404-6540

NPI assigned

Jul 23, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shock Therapy Group LLCGroup PAC ID 6406394352, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

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.

• Shock Therapy Group LLC

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1538869532
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1255984738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 BROADWAY",
            "address_2": "BUILDING 19, SUITE 10",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022012",
            "telephone_number": "260-200-4940",
            "fax_number": "949-404-6540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 BROADWAY",
            "address_2": "BUILDING 19, SUITE 10",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022012",
            "telephone_number": "260-200-4940",
            "fax_number": "949-404-6540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCK",
        "first_name": "JENNA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71009466A",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IN",
            "license": "28184986A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300031451",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristina Shively, LPN
• Monica Shively, LPN
• Sonya Ann Shively, DDS
• Susan Shively, LMT
• Shock Therapy Group LLC
• Gabrielle Shockome
• Hallie Shockome, BCBA
• Pamela Sue Shoda, N.P.
• Corinna Shoemaker
• Eric Shoemaker

• Psychiatric/Mental Health Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; 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.