Individual provider Active NPI

Carolyn Jo Lane, NP

  • Nurse Practitioner
  • Marion, IN
National Provider Identifier
1497911051
Registry record updated Aug 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71002663A Issued in IN
Practice address
441 N Wabash Ave
Marion, IN 46952-2612
Phone
(765) 660-6411
NPI assigned
Aug 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71002663A IN Primary

Addresses

Primary practice location

441 N Wabash Ave
Marion, IN 46952-2612

Mailing address

330 North Wabash Ave
Suite G20
Marion, IN 46952-2600
Phone (765) 660-7600

Other identifiers 2

IdentifierTypeStateIssuer
000000579524OtherANTHEM
200916820MedicaidIN

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
I20081013000480 IN Practitioner - Nurse Practitioner 3274601679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marion General HospitalGroup PAC ID 9133023625, 115 clinicians

Practice addresses (Care Compare)

441 N Wabash Ave
Marion, IN 46952-2612
Phone (765) 660-6000

4781 Kaybee Dr
Gas City, IN 46933-6607
Phone (765) 660-7840

Hospital & facility affiliations

  • Marion General Hospital Hospital, Marion, IN, CCN 150011

Merit-based Incentive Payment System (MIPS)

Final score
85.82 of 100Reported as group
Quality
71.45
Promoting interoperability
100
Improvement activities
40
Cost
75.59

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71002663AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Marion General Hospital CurrentSince Aug 1, 2008 Accepting new patients
Marion General Hospital CurrentSince Aug 1, 2008 Accepting new patients

Locations

4781 Kaybee Dr
Gas City, IN 46933
Phone (765) 660-7840

330 N Wabash Ave
Ste G-20
Marion, IN 46952
Phone (765) 660-7600

441 N Wabash Ave
Marion, IN 46952
Phone (219) 482-4577

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375315200000",
    "number": "1497911051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 NORTH WABASH AVE",
            "address_2": "SUITE G20",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522600",
            "telephone_number": "765-660-7600",
            "fax_number": "765-651-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 N WABASH AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522612",
            "telephone_number": "765-660-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "CAROLYN",
        "middle_name": "JO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2013-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71002663A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000579524",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200916820",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.