Individual provider Active NPI

Nicole Ashley Wheeler

  • Adult Health Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1346975356
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
71012836A Issued in IN
Practice address
610 N Michigan St Ste 400
South Bend, IN 46601-1081
Phone
(574) 647-8120
Fax
(574) 647-8111
NPI assigned
Jul 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71023836A IN
Adult Health Nurse Practitioner 363LA2200X 71012836A IN Primary

Addresses

Primary practice location

610 N Michigan St Ste 400
South Bend, IN 46601-1081

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other practice location 1

17475 Dugdale Dr
South Bend, IN 46635-1545
Phone (574) 247-7500

Other practice location 2

610 N Michigan St Ste 306
South Bend, IN 46601-1079
Phone (574) 647-6500

Other identifiers 1

IdentifierTypeStateIssuer
300038057MedicaidIN

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
I20221116000436 IN Practitioner - Nurse Practitioner 1456729862 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

610 N Michigan St
400 BMG Adv Cardiology Specialists
South Bend, IN 46601-1081
Phone (574) 647-8120

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71023836AINMDNurse Practitioner
71012836AINMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Informe HC Specialists, LLC CurrentSince Sep 1, 2023 Accepting new patients
Beacon Medical Group, Inc. CurrentSince Feb 24, 2025 Accepting new patients
Beacon Medical Group Inc CurrentSince Feb 24, 2025 Accepting new patients
Informe Healthcare LLC CurrentSince Aug 12, 2022 Accepting new patients
Informe Healthcare in, LLC CurrentSince Aug 12, 2022 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

745 N Swope St
Greenfield, IN 46140
Phone (317) 462-9221

2860 Churchman Ave
Indianapolis, IN 46203
Phone (317) 787-3451

8800 Virginia Pl
Merrillville, IN 46410
Phone (219) 736-1310

811 E 12th St
Mishawaka, IN 46544
Phone (574) 249-1917

609 Tanglewood Ln
Mishawaka, IN 46545
Phone (574) 277-2500

1420 E Douglas Rd
Mishawaka, IN 46545
Phone (574) 307-7200

610 N Michigan St
Ste 400
South Bend, IN 46601
Phone (574) 204-7333

17475 Dugdale Dr
South Bend, IN 46635
Phone (574) 247-7500

610 N Michigan St
Ste 306
South Bend, IN 46601
Phone (574) 647-6500

2741 W Layton Ave
Ste 106
Milwaukee, WI 53221

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1346975356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N MICHIGAN ST STE 400",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011081",
            "telephone_number": "574-647-8120",
            "fax_number": "574-647-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17475 Dugdale Dr",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466351545",
            "country_code": "US",
            "telephone_number": "574-247-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 N Michigan St Ste 306",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011079",
            "country_code": "US",
            "telephone_number": "574-647-6500",
            "fax_number": "574-647-6518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "NICOLE",
        "middle_name": "ASHLEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71023836A",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71012836A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300038057",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.