Individual provider Active NPI

Virginia L Nider, NP

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1609124940
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71004830A Issued in IN
Practice address
1234 E Dupont Rd Ste 1
Fort Wayne, IN 46825-1545
Phone
(260) 266-6060
Fax
(260) 425-6395
NPI assigned
Aug 16, 2012
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A0412039 OH
Nurse Practitioner 363L00000X 71004830A IN Primary

Addresses

Primary practice location

1234 E Dupont Rd Ste 1
Fort Wayne, IN 46825-1545

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other identifiers 2

IdentifierTypeStateIssuer
201211560MedicaidIN
P01307605OtherINMEDICARE RR PTAN

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
I20140318002036 IN Practitioner - Nurse Practitioner 3476705716 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

11104 Parkview Circle Dr
Fort Wayne, IN 46845-1672
Phone (206) 266-5400

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone (260) 425-6030

11115 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone (260) 672-6443

1234 E Dupont Rd
Fort Wayne, IN 46825-1545

1234 E Dupont Road
3 PPG Integrative Medicine
Fort Wayne, IN 46825-1545
Phone (260) 672-6590

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A0412039OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System,Inc. Nurse Practitioner CurrentSince Oct 2, 2024 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Feb 1, 2014 Accepting new patients
Parkview Health System Inc Nurse Practitioner Current Accepting new patients
Community Physicians of Indiana Inc CurrentSince Feb 1, 2014 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

1234 E DuPont Rd
Ste 1
Fort Wayne, IN 46825
Phone (260) 266-6060

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

1400 N Ritter Ave
Ste 520
Indianapolis, IN 46219
Phone (317) 355-1234

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

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

Organizations & group practices 4

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 1

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": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1609124940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 E DUPONT RD STE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251545",
            "telephone_number": "260-266-6060",
            "fax_number": "260-425-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIDER",
        "first_name": "VIRGINIA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-16",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "A0412039",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71004830A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201211560",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PTAN",
            "identifier": "P01307605",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.