Active NPI
Jack Chitenje
- Gerontology Nurse Practitioner
- Fishers, IN
National Provider Identifier
1598327009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- PENDING
- Practice address
- 13914 Boulder Canyon Dr
Fishers, IN 46038-5361 - Phone
- (574) 210-9966
- NPI assigned
- Jul 3, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | PENDING | IN | Primary |
Addresses
Primary practice location
13914 Boulder Canyon Dr
Fishers, IN 46038-5361
Mailing address
13914 Boulder Canyon Dr
Fishers, IN 46038-5361
Phone (574) 210-9966
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191230000054 | IN | Practitioner - Nurse Practitioner | 7911331913 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | IN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562112000000",
"number": "1598327009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13914 BOULDER CANYON DR",
"city": "FISHERS",
"state": "IN",
"postal_code": "460385361",
"telephone_number": "574-210-9966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13914 BOULDER CANYON DR",
"city": "FISHERS",
"state": "IN",
"postal_code": "460385361",
"telephone_number": "574-210-9966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHITENJE",
"first_name": "JACK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-03",
"last_updated": "2019-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IN",
"license": "PENDING",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fishers, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.