Maryam Egenolf, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

71012571A Issued in IN

Practice address

2651 E Discovery Pkwy
Bloomington, IN 47408-9059

Phone

(812) 918-3400

Fax

(812) 335-7371

NPI assigned

Apr 15, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Maryam Elghouche Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY, IN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

University of Cincinnati College of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Indiana University Health Southern Indiana Physicians LLCGroup PAC ID 6204748197, 474 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: melghouche@direct.iuhealth.org
• FHIR API: https://api.platform.athenahealth.com/2183/brand/318/csg/2083/fhir/r4

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.

• Indiana University Health Southern Indiana Physicians, LLC

  • Multi-Specialty Clinic/Center
  • Bloomington, IN
  • NPI 1013953983

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Medical Care for Women, PC

  • Specialist
  • Astoria, NY
  • NPI 1942475793

  Single Specialty

  Medicare reassignment NPD
• Indiana University Health Southern Indiana Physicians LLC

  • Durable Medical Equipment & Medical Supplies
  • Bloomington, IN
  • NPI 1063179844
  NPD
• East Coast Anesthesia PC

  • Anesthesiology Physician
  • Flushing, NY
  • NPI 1003053794

  Single Specialty

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indiana University Health Bloomington Inc

  • General Acute Care Hospital
  • Bloomington, IN
  • NPI 1205860335
  Care Compare affiliation

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1497336176",
    "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": "2651 E DISCOVERY PKWY",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474089059",
            "telephone_number": "812-918-3400",
            "fax_number": "812-335-7371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2322 30th Rd Ste 1A",
            "address_purpose": "LOCATION",
            "city": "Astoria",
            "state": "NY",
            "postal_code": "111023238",
            "country_code": "US",
            "telephone_number": "718-278-0888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EGENOLF",
        "first_name": "MARYAM",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-15",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "F421487-01",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IN",
            "license": "71012571A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "melghouche@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2651 E Discovery Pkwy",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474089059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARYAM",
            "last_name": "ELGHOUCHE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Leanne E Eddington
• Cameron O'Neal Edwards
• Katie Edwards, MS, OTR
• Kelsi Edwards
• McKenna Edwards
• Jack Thomas Egnatz
• Richard J Eisenhut, MD
• Paula F Eiteljorge, RN
• Lynn El Daher
• Elders Journey Home Care, LLC

• Women's Health Nurse Practitioner in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Women's Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.