Individual provider Active NPI

John Sizemore, MSN AG-ACNP

  • Gerontology Nurse Practitioner
  • Greenwood, IN
National Provider Identifier
1629649314
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71011422A Issued in IN
Practice address
701 E County Line Rd Ste 101
Greenwood, IN 46143-1070
Phone
(317) 885-2860
NPI assigned
Jul 5, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 71011422A IN
Gerontology Clinical Nurse Specialist 364SG0600X 71011422A IN
Gerontology Nurse Practitioner 363LG0600X 71011422A IN Primary

Addresses

Primary practice location

701 E County Line Rd Ste 101
Greenwood, IN 46143-1070

Mailing address

701 E County Line Rd Ste 101
Greenwood, IN 46143-1070

Other identifiers 1

IdentifierTypeStateIssuer
300054753MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct.indianainternalmedicine@ccme.com Direct

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
I20210817001724 IN Practitioner - Nurse Practitioner 0547665341 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Indiana Medical College, School of Medicine of Purdue University, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Francis Medical Group LLCGroup PAC ID 7012067697, 113 clinicians

Practice addresses (Care Compare)

701 E County Line Rd
Suite 101
Greenwood, IN 46143-1070
Phone (317) 885-2860

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
71011422AINMDGerontology Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana Internal Medicine Consultants, LLC. Acute Care CurrentSince Aug 9, 2021 Accepting new patients
St. Francis Medical Group, LLC Acute Care CurrentSince Aug 9, 2021 Accepting new patients
St Francis Medical Group LLC CurrentSince Aug 9, 2021 Accepting new patients

Locations

701 E County Line Rd
Ste 101
Greenwood, IN 46143
Phone (317) 885-2860

Interoperability endpoints

  • Direct secure messaging: jsizemore407515@direct.franciscanalliance.org
  • Direct secure messaging: direct.indianainternalmedicine@ccme.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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1625443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1629649314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 101",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 101",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431070",
            "telephone_number": "317-885-2860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIZEMORE",
        "first_name": "JOHN",
        "credential": "MSN AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-05",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "71011422A",
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "IN",
            "license": "71011422A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71011422A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300054753",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct.indianainternalmedicine@ccme.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "701 E County Line Rd Ste 101",
            "city": "Greenwood",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461431070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

Verify at the official NPI Registry.