Individual provider Active NPI

Jaclyn Nicasio, NP

  • Nurse Practitioner
  • Anderson, IN
National Provider Identifier
1578367363
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71016449A Issued in IN
Practice address
1629 Medical Arts Blvd Ste 120
Anderson, IN 46011-3454
Phone
(765) 298-4220
Fax
(765) 298-4942
NPI assigned
Apr 2, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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 71016449A IN Primary

Addresses

Primary practice location

1629 Medical Arts Blvd Ste 120
Anderson, IN 46011-3454

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890

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
I20250514001671 IN Practitioner - Nurse Practitioner 0244758209 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians
Community Physician Network Specialty Care LLCGroup PAC ID 9931697265, 260 clinicians

Practice addresses (Care Compare)

1629 Medical Arts Blvd
Suite 120
Anderson, IN 46011-3454
Phone (765) 298-4220

8075 N Shadeland Ave
Indianapolis, IN 46250-2693
Phone (317) 621-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71016449AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physician Network Specialty Care LLC CurrentSince Dec 8, 2025 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Jun 9, 2025 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Jun 9, 2025 Accepting new patients

Locations

5918 Reliable Pkwy
Chicago, IL 60686

5819 Reliable Pkwy
Chicago, IL 60686

1629 Medical Arts Blvd
#120
Anderson, IN 46011
Phone (765) 298-2400

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000

7979 N Shadeland Ave
Ste 200
Indianapolis, IN 46250
Phone (317) 621-3300

Interoperability endpoints

  • Direct secure messaging: jnicasio527918@ecommunitydirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1743552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1578367363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 MEDICAL ARTS BLVD STE 120",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113454",
            "telephone_number": "765-298-4220",
            "fax_number": "765-298-4942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICASIO",
        "first_name": "JACLYN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-02",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71016449A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, IN

Sources for this page

Verify at the official NPI Registry.