Shock Therapy Group LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

SHOCK THERAPY GROUP LLC

Practice address

1690 Broadway Ste 10
Fort Wayne, IN 46802-4377

Phone

(260) 200-4940

NPI assigned

Mar 8, 2023

Last updated

Dec 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jenna ShockNPI 1255984738

Title

Owner

Phone

(260) 200-4940

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jenna L Shock, MSN, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1255984738
  Medicare reassignment Care Compare group Authorized official
• Jessica Erebor, MSED

  • Marriage & Family Therapist
  • Fort Wayne, IN
  • NPI 1649761503
  Medicare reassignment Care Compare group NPD
• Angelica Wilson, MSN, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1952297533
  Medicare reassignment Care Compare group NPD
• Emily Redman

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1851923627
  Medicare reassignment NPD

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1538869532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14606 BITTERNUT LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468149062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 BROADWAY STE 10",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468024377",
            "telephone_number": "260-200-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOCK THERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-08",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "SHOCK",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-200-4940"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob C Shively
• Kristina Shively, LPN
• Monica Shively, LPN
• Sonya Ann Shively, DDS
• Susan Shively, LMT
• Jenna L Shock, MSN, APRN, PMHNP-BC
• Gabrielle Shockome
• Hallie Shockome, BCBA
• Pamela Sue Shoda, N.P.
• Corinna Shoemaker

• 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 Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.