Individual provider Active NPI

Julie Ann Mallers

  • Family Nurse Practitioner
  • Crown Point, IN
National Provider Identifier
1396913646
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71002367A Issued in IN
Practice address
1121 S Indiana Ave
Crown Point, IN 46307-7205
Phone
(219) 663-2160
NPI assigned
Feb 20, 2008
Last updated
Mar 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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 71002367A IN Primary
Primary Care Nurse Practitioner 363LP2300X 71002367 IN

Addresses

Primary practice location

1121 S Indiana Ave
Crown Point, IN 46307-7205

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

8345 Wicker Ave
Saint John, IN 46373-8879
Phone (219) 627-5077

Other practice location 2

1201 S Main St
Crown Point, IN 46307-8481
Phone (219) 757-6629

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmallers4750@Direct.FranciscanAlliance.org Direct

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
I20160617000394 IN Practitioner - Nurse Practitioner 1759672017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indiana Sports and Medical Science Institute, PCGroup PAC ID 2860662517, 7 clinicians

Practice addresses (Care Compare)

11275 Delaware Pkwy
Suite a
Crown Point, IN 46307-7812
Phone (219) 779-8735

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71002367AINMDFamily Nurse Practitioner
71002367INMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana Sports & Medical Science Institute, PC CurrentSince Feb 15, 2022 Accepting new patients

Locations

11275 Delaware Pkwy
Crown Point, IN 46307
Phone (219) 779-8735

11275 Delaware Pkwy
#A
Crown Point, IN 46307
Phone (219) 662-5530

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: jmallers@isamsip-in.direct.office.nextgen.com
  • Direct secure messaging: jmallers4750@direct.franciscanalliance.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1396913646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 S INDIANA AVE",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077205",
            "telephone_number": "219-663-2160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8345 Wicker Ave",
            "address_purpose": "LOCATION",
            "city": "Saint John",
            "state": "IN",
            "postal_code": "463738879",
            "country_code": "US",
            "telephone_number": "219-627-5077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 S Main St",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463078481",
            "country_code": "US",
            "telephone_number": "219-757-6629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLERS",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-20",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002367A",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IN",
            "license": "71002367",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmallers4750@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1201 S Main St",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463078481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.