Individual provider Active NPI

Jennifer Mae Potter, MS, ANP-BC

  • Adult Health Nurse Practitioner
  • Elkhart, IN
National Provider Identifier
1417209347
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
71004185A Issued in IN
Practice address
500 Arcade Ave Ste 200
Elkhart, IN 46514-2485
Phone
(574) 294-8404
Fax
(574) 523-1642
NPI assigned
Oct 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 71004185A IN Primary

Addresses

Primary practice location

500 Arcade Ave Ste 200
Elkhart, IN 46514-2485

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-2713

Other practice location 1

1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1700

Other practice location 2

2222 Rieth Blvd Suite 104
Goshen, IN 46526-5869
Phone (574) 875-1082

Other identifiers 1

IdentifierTypeStateIssuer
201271860MedicaidIN

Other names 1

  • Jennifer Mae Hacker Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmpotter@mybeacon.cernerdirect.com

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
I20121017000234 IN Practitioner - Nurse Practitioner 2860642485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
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)

100 Navarre PL
6600 BMG N Central Neurosurgery SB
South Bend, IN 46601-1173
Phone (574) 647-8800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Oct 7, 2019 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. CurrentSince Oct 7, 2019 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

500 Arcade Ave
Ste 200
Elkhart, IN 46514
Phone (574) 232-7227

2222 Rieth Blvd
Ste 104
Goshen, IN 46526
Phone (574) 875-1082

2240 Karisa Dr
Ste 1
Goshen, IN 46526
Phone (574) 522-0265

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

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

1815 E Ireland Rd
South Bend, IN 46614
Phone (574) 647-1700

100 Navarre Pl
Ste 6600
South Bend, IN 46601
Phone (574) 232-7227

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

Organizations & group practices 4

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 5

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": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1417209347",
    "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",
            "telephone_number": "574-647-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 200",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142485",
            "telephone_number": "574-294-8404",
            "fax_number": "574-523-1642"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E Ireland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-1700",
            "fax_number": "574-647-7572",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 Rieth Blvd Suite 104",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465265869",
            "country_code": "US",
            "telephone_number": "574-875-1082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTER",
        "first_name": "JENNIFER",
        "middle_name": "MAE",
        "credential": "MS, ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71004185A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201271860",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmpotter@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "500 Arcade Ave Ste 200",
            "city": "Elkhart",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465142485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "HACKER",
            "middle_name": "MAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.