Jennifer Cunningham, PT, DPT
Individual provider Active NPI Physical Therapist · Granger, IN
NPI 1346711652 · NPPES record last updated Mar 31, 2021
Key facts
- NPI
- 1346711652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05010151A (IN)
- Practice address
- 3221 Beacon Pkwy Ste 100
Granger, IN 46530-7196 - Phone
- (574) 647-2930
- Fax
- (574) 647-2935
- NPI assigned
- Dec 13, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190416001452 | IN | Practitioner - Physical Therapist in Private Practice | 1759622988 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05010151A | IN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group, Inc. | Past |
Accepting new patients | |
| Beacon Health, LLC | Past | Accepting new patients |
Interoperability endpoints
- jcunningham@mybeacon.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05010151A | IN | Yes |
Addresses
Primary practice location
3221 Beacon Pkwy Ste 100
Granger, IN 46530-7196
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other practice location 1
1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-5790
Other practice location 2
900 I St Ste 100
LA Porte, IN 46350-5533
Phone (219) 324-1730
Other practice location 3
200 E Jackson Blvd Ste 150
Elkhart, IN 46516-3513
Phone (574) 389-5558
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300024119 | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jcunningham@mybeacon.cernerdirect.com |
Other providers in Granger, IN
- Costco Wholesale Corporation
- Costco Wholesale Corporation
- Ronald A. Craker
- Christa Marie Crawford
- Kelly E Crowley
- Tess Lacie Curnyn
- Cynthia Shepherd, LCSW, LLC
- Stacey Ann Dalby
- Karen D. Davis
- Oliver James Davis Jr.
All providers in Granger, IN · Physical Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.