Nwi Mdvip LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NWI MDVIP LLC

Practice address

9150 E 109TH Ave Ste 2B
Crown Point, IN 46307-7686

Phone

(219) 213-2947

Fax

(219) 310-8175

NPI assigned

Nov 14, 2022

Organization subpart

No

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

Authorized official

Name

Brent A Jacobus, DONPI 1902807589

Title

Owner

Phone

(219) 306-0752

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: brent.jacobus@wfml-in.direct.office.nextgen.com

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Refuge Clinic, LLC

  • Addiction Medicine (Family Medicine) Physician
  • Crown Point, IN
  • NPI 1548148752
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent A Jacobus, D.O.

  • Family Medicine Physician
  • Crown Point, IN
  • NPI 1902807589
  Medicare reassignment Care Compare group NPD Authorized official
• Brett A Brechner, DO

  • Family Medicine Physician
  • Crown Point, IN
  • NPI 1629079108
  Medicare reassignment Care Compare group NPD
• Wendy Vottero, FNP-BC

  • Family Nurse Practitioner
  • Gary, IN
  • NPI 1699141184
  Medicare reassignment NPD

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1538877972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9150 E 109TH AVE STE 2B",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077686",
            "telephone_number": "219-306-0752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9150 E 109TH AVE STE 2B",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077686",
            "telephone_number": "219-213-2947",
            "fax_number": "219-310-8175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NWI MDVIP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "JACOBUS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-306-0752",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200380090",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100200720",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brent.jacobus@WFML-IN.direct.office.nextgen.com",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9150 E 109th Ave Ste 2B",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463077686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.