NPIMap

Individual provider Active NPI

Jennifer Cullen Pallansch, MD

  • Emergency Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1407351414
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
01085494A Issued in IN
Practice address
720 Eskenazi Ave
Indianapolis, IN 46202-5187
Phone
(317) 944-1952
NPI assigned
Mar 30, 2018
Last updated
Jul 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 238333 NC
Emergency Medicine Physician 207P00000X 01085494A IN Primary

Addresses

Primary practice location

720 Eskenazi Ave
Indianapolis, IN 46202-5187

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221003001243 NC Practitioner - Emergency Medicine 0648527127 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

3536 Mt Holly Huntersville Rd
Charlotte, NC 28216-8644
Phone (336) 716-2255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
238333NCMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Current Accepting new patients
Wake Forest Emergency Providers CurrentSince Jul 18, 2022 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Oct 3, 2022 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Oct 3, 2022 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Medical Center Emergency Medicine CurrentSince Oct 3, 2022 Accepting new patients
Carolinas Medical Center CurrentSince Oct 3, 2022 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

3536 Mt Holly Huntersville Rd
Charlotte, NC 28216
Phone (704) 801-6500

Interoperability endpoints

  • Direct secure messaging: jpallansch87145@direct.eskenazihealth.edu

Organizations & group practices 8

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 8

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": "1522368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1407351414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 ESKENAZI AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025187",
            "telephone_number": "317-944-1952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALLANSCH",
        "first_name": "JENNIFER",
        "middle_name": "CULLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-30",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "238333",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01085494A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.