Individual provider Active NPI

Consolacion Monica B Chan, FNP-C

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1568050805
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71010626A Issued in IN
Practice address
1700 W 10TH St
Indianapolis, IN 46222-3802
Phone
(317) 636-4400
NPI assigned
Jan 4, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71010626A IN Primary

Addresses

Primary practice location

1700 W 10TH St
Indianapolis, IN 46222-3802

Mailing address

21 Eastbrook BND Ste 218
Peachtree City, GA 30269-1546
Phone (260) 407-8009

Other practice location 1

8333 Naab Rd Ste 230
Indianapolis, IN 46260-1983
Phone (317) 415-6580

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
I20210122002461 IN Practitioner - Nurse Practitioner 1456765023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

8333 Naab Rd
230 Ascension Medical Group St. Vincent
Indianapolis, IN 46260-5924
Phone (317) 415-6580

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Medical Group, Inc. Family CurrentSince Sep 2, 2024 Accepting new patients
St. Vincent Medical Group, Inc. CurrentSince Sep 2, 2024 Accepting new patients

Locations

8433 Harcourt Rd
Ste 100
Indianapolis, IN 46260
Phone (317) 583-7702

8333 Naab Rd
Ste 230
Indianapolis, IN 46260
Phone (317) 415-6580

250 W 96th St
Ste 520
Indianapolis, IN 46260
Phone (317) 583-3211

Interoperability endpoints

  • Direct secure messaging: consolacion.chan.1@7598.direct.athenahealth.com
  • Direct secure messaging: cburgos290286@ecommunitydirect.com

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 2

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": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1568050805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "260-407-8009",
            "fax_number": "260-407-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W 10TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462223802",
            "telephone_number": "317-636-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8333 Naab Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462601983",
            "country_code": "US",
            "telephone_number": "317-415-6580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CONSOLACION MONICA",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71010626A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.