Individual provider Active NPI

Dale Poortenga, FNP

  • Family Nurse Practitioner
  • Hammond, IN
National Provider Identifier
1265248504
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71016085A Issued in IN
Practice address
Midwest Express Clinic
31 Sibley St Ste a
Hammond, IN 46320
Phone
(219) 802-8800
NPI assigned
Dec 10, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71016085A IN Primary

Addresses

Primary practice location

Midwest Express Clinic
31 Sibley St Ste a
Hammond, IN 46320

Mailing address

Midwest Express Clinic
31 Sibley St Ste a
Hammond, IN 46320
Phone (219) 802-8800

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
I20241223002179 IN Practitioner - Nurse Practitioner 6608303136 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 4 LLCGroup PAC ID 4284909615, 64 clinicians
Nwi Urgent Care, LLCGroup PAC ID 7618142977, 45 clinicians

Practice addresses (Care Compare)

31 E Sibley St
Suite a
Hammond, IN 46320-1725
Phone (219) 802-8800

8135 Calumet Ave
Munster, IN 46321-1701
Phone (219) 513-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71016085AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 4 LLC CurrentSince Nov 26, 2024 Accepting new patients
Nwi Urgent Care, LLC CurrentSince Nov 26, 2024 Accepting new patients
Midwest Express Care, Inc CurrentSince Nov 26, 2024 Accepting new patients
Midwest Express Care 4 LLC CurrentSince Nov 26, 2024 Accepting new patients
The Methodist Hospitals, Inc PastSince Nov 26, 2024 Accepting new patients

Locations

31 Sibley St
Ste A
Hammond, IN 46320
Phone (219) 802-8800

8135 Calumet Ave
Munster, IN 46321
Phone (219) 513-2000

1500 US Highway 41
Schererville, IN 46375
Phone (219) 440-7373

Organizations & group practices 5

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": "1733788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1265248504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MIDWEST EXPRESS CLINIC",
            "address_2": "31 SIBLEY ST STE A",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "46320",
            "telephone_number": "219-802-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MIDWEST EXPRESS CLINIC",
            "address_2": "31 SIBLEY ST STE A",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "46320",
            "telephone_number": "219-802-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POORTENGA",
        "first_name": "DALE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-10",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71016085A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, IN

Sources for this page

Verify at the official NPI Registry.