Joelyn M Etgen, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71003840A Issued in IN

Practice address

770 E Dupont Rd
Fort Wayne, IN 46825-2056

Phone

(260) 451-8242

NPI assigned

Jan 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Joelyn Marie Etgen Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: joelyn.etgen.1@14940.direct.athenahealth.com

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.

• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  OH

  Medicare reassignment NPD
• Nephrology Associates of Northern Indiana, Inc

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1578505814
  NPD (past)
• Parkview Health System Inc

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952

  Nurse Practitioner

  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Mathew M. Jose, M.D., Inc

  • Family Medicine Physician
  • Wapakoneta, OH
  • NPI 1447352786
  NPD (past)

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1467722249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252056",
            "telephone_number": "260-451-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252056",
            "telephone_number": "260-451-8242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13410 Main St",
            "address_purpose": "LOCATION",
            "city": "Grabill",
            "state": "IN",
            "postal_code": "467412001",
            "country_code": "US",
            "telephone_number": "260-627-2242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "443 Donelson Pike Ste 200",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372143571",
            "country_code": "US",
            "telephone_number": "301-809-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETGEN",
        "first_name": "JOELYN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-10",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA 13375-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003840A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201047530",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076586",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12330800",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "M40062495",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "H149901",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.complexcaresolutions.com/",
            "affiliation": "Y",
            "affiliationName": "Inovalon",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "443 Donelson Pike Ste 200",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372143571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOELYN",
            "last_name": "ETGEN",
            "middle_name": "MARIE",
            "credential": "NP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Christopher Esterling
• Lyric Esters, RBT
• James Ellwood Estey, ATC
• Eduardo Estrada Martinez
• Jenniffer Gaite Etchison, PT
• Faith Elizabeth Etherington, PA
• Sheryl J Etnier-Colon, NP
• Kaitlin Etzcorn, NP-C
• Dawn Lesley Etzel
• Kam Ellen Etzler, RPH

• Family Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.