Individual provider Active NPI

Jenna K Maple, NNP-BC

  • Neonatal Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1356832638
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
71007986A Issued in IN
Practice address
1500 N Ritter Ave
Indianapolis, IN 46219-3027
Phone
(317) 274-4779
Fax
(317) 948-9806
NPI assigned
May 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 28207435A IN
Neonatal Nurse Practitioner 363LN0000X 71007986A IN Primary

Addresses

Primary practice location

1500 N Ritter Ave
Indianapolis, IN 46219-3027

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890

Other identifiers 1

IdentifierTypeStateIssuer
300018623MedicaidIN

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
I20180927001957 IN Practitioner - Nurse Practitioner 7719238914 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28207435AINMDNeonatal Nurse Practitioner
71007986AINMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Aug 1, 2022 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Aug 1, 2022 Accepting new patients
St Vincent Pediatric Subspecialties CurrentSince Oct 8, 2018 Accepting new patients
St Vincent Pediatric Subspecialties CurrentSince Oct 8, 2018 Accepting new patients
Iu Health Medical Group, LLC Past Accepting new patients
University Pediatric Associates, Inc. Past Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

2001 W 86th St
Indianapolis, IN 46260
Phone (317) 338-3617

8081 Township Line Rd
Ste 203
Indianapolis, IN 46260
Phone (317) 415-7921

1500 N Ritter Ave
Indianapolis, IN 46219
Phone (317) 355-5041

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

8111 Township Line Rd
Indianapolis, IN 46260
Phone (317) 415-7921

Interoperability endpoints

  • Direct secure messaging: jhentrup67947@ecommunitydirect.com

Organizations & group practices 6

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": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1356832638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N RITTER AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462193027",
            "telephone_number": "317-274-4779",
            "fax_number": "317-948-9806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAPLE",
        "first_name": "JENNA",
        "middle_name": "K",
        "credential": "NNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-23",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "IN",
            "license": "28207435A",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "IN",
            "license": "71007986A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300018623",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.