Active NPI
Jessica Erebor, MSED
- Marriage & Family Therapist
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 2100 Goshen Rd
Fort Wayne, IN 46808-1493 - Phone
- (260) 471-3500
- NPI assigned
- May 25, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
2100 Goshen Rd
Fort Wayne, IN 46808-1493
Mailing address
2621 E Jefferson St
Warsaw, IN 46580-3880
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Marriage and Family Therapist
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5743 Wilkie Dr
Suite 3
Fort Wayne, IN 46804-8905
Phone (260) 200-4940
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bowen Health Inc | Current | Accepting new patients | |
| Shock Therapy Group LLC | Current | Accepting new patients | |
| Bowen Health Inc | Current | Accepting new patients |
Locations
1259 E State Road 205
Columbia City, IN 46725
Phone (260) 248-8176
5743 Wilkie Dr
Ste 3
Fort Wayne, IN 46804
Phone (260) 200-4940
2100 Goshen Rd
Fort Wayne, IN 46808
Phone (260) 471-3500
1690 Broadway
Ste 19
Fort Wayne, IN 46802
Phone (260) 200-4940
2621 E Jefferson St
Warsaw, IN 46580
Phone (574) 269-0573
850 N Harrison St
Warsaw, IN 46580
Phone (219) 267-7169
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.
-
- Family Nurse Practitioner
- Fort Wayne, IN
- NPI 1538869532
-
- Adult Mental Health Clinic/Center
- Warsaw, IN
- NPI 1639172810
-
- Federally Qualified Health Center (FQHC)
- Fort Wayne, IN
- NPI 1023668183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635811200000",
"number": "1649761503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2621 E JEFFERSON ST",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 GOSHEN RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468081493",
"telephone_number": "260-471-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EREBOR",
"first_name": "JESSICA",
"credential": "MSED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-25",
"last_updated": "2021-11-02",
"certification_date": "2021-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.