Thomas Edwin Puckett Jr., N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71005644A Issued in IN

Practice address

3834 S Emerson Ave
BLDG C Ste 100
Indianapolis, IN 46203

Phone

(317) 782-1577

Fax

(888) 366-7577

NPI assigned

Aug 6, 2015

Last updated

Aug 2, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Post Acute Medical PLLCGroup PAC ID 5193156115, 433 clinicians

Altea Medical Indiana PCGroup PAC ID 4183064389, 24 clinicians

Novenza Practice Group IIGroup PAC ID 3678057312, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hoosier Homecare Services LLC Home health agency, Anderson, IN, CCN 157608

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Altea Medical Indiana PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Gary, IN
  • NPI 1992584783
  Medicare reassignment Care Compare group NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  IN

  Medicare reassignment Care Compare group NPD
• Novenza Practice Group II

  • Geriatric Medicine (Internal Medicine) Physician
  • Greenwood, IN
  • NPI 1417806068
  Medicare reassignment Care Compare group
• Advanced Healthcare Associates LLP

  • Geriatric Medicine (Internal Medicine) Physician
  • Elwood, IN
  • NPI 1841225091

  Nurse Practitioner

  Medicare reassignment NPD
• Novenza Practice Group

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1609268259
  Medicare reassignment
• Hospitalist Medicine Physicians of Mississippi-TCS, Inc.

  • Internal Medicine Physician
  • St Augustine, FL
  • NPI 1023866597

  IN

  Medicare reassignment
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

• Hoosier Homecare Services, LLC

  • Home Health Agency
  • Anderson, IN
  • NPI 1801075049
  Care Compare affiliation

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

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1346626876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3299",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897023299",
            "telephone_number": "775-222-0044",
            "fax_number": "888-700-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3834 S EMERSON AVE",
            "address_2": "BLDG C STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46203",
            "telephone_number": "317-782-1577",
            "fax_number": "888-366-7577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "THOMAS",
        "middle_name": "EDWIN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-06",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71005644A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201312180",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Izabella Puchalski
• Andrew Quentin Pucka
• Jennifer Puckett
• Kristain Joan Puckett, OTR
• Kristen Puckett
• Anna Claire Puderbaugh
• Bianca Puello, MD
• Donna Puello
• Janelle Winifred Puff
• Sarah Mae Puffer, M.D.

• Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; 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.