NPIMap

Individual provider Active NPI

Marilyn J. Riley, PHD, NP

  • Adult Health Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1316928112
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
71000828A Issued in IN
Practice address
1701 N Senate Ave
3007
Indianapolis, IN 46202-5306
Phone
(317) 962-5097
Fax
(317) 962-5018
NPI assigned
Nov 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71000828A IN
Adult Health Nurse Practitioner 363LA2200X 71000828A IN Primary

Addresses

Primary practice location

1701 N Senate Ave
3007
Indianapolis, IN 46202-5306

Mailing address

250 N Shadeland Ave
Ste 130 Provider Enrollment
Indianapolis, IN 46219-4959

Other practice location 1

2600 Ferry St
Lafayette, IN 47904-3055
Phone (765) 448-8000

Other identifiers 2

IdentifierTypeStateIssuer
000001126642OtherINANTHEM PROVIDER NUMBER
200843250MedicaidIN

Other names 1

  • Marilyn J. Chestnut Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostics of Indiana, LLC Family Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1316928112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "STE 130 PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N SENATE AVE",
            "address_2": "3007",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025306",
            "telephone_number": "317-962-5097",
            "fax_number": "317-962-5018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Ferry St",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479043055",
            "country_code": "US",
            "telephone_number": "765-448-8000",
            "fax_number": "765-838-4698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "MARILYN",
        "middle_name": "J.",
        "name_prefix": "Prof.",
        "credential": "PHD, NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71000828A",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71000828A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000001126642",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200843250",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "CHESTNUT",
            "middle_name": "J.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.