Individual provider Active NPI

Cheryl Shively, FNP-C

  • Family Nurse Practitioner
  • Logansport, IN
National Provider Identifier
1649840521
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28168027A Issued in IN
Practice address
1101 Michigan Ave
Logansport, IN 46947-1528
Phone
(574) 753-7541
NPI assigned
Jul 1, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 28168027A IN Primary

Addresses

Primary practice location

1101 Michigan Ave
Logansport, IN 46947-1528

Mailing address

1921 N 3Rd St
Logansport, IN 46947-1010
Phone (765) 860-2063

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
I20210903000425 IN Practitioner - Nurse Practitioner 5698171361 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkview Logansport Hospital IncGroup PAC ID 8921500646, 41 clinicians
Memorial HospitalGroup PAC ID 8123923281, 64 clinicians

Practice addresses (Care Compare)

1025 Michigan Ave
Suite 15
Logansport, IN 46947-1593
Phone (574) 753-9000

3400 E Market St
Logansport Memorial Express Medical Center
Logansport, IN 46947-2295
Phone (574) 722-9633

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Logansport Hospital, Inc. CurrentSince Sep 1, 2021 Accepting new patients
Parkview Logansport Hospital, Inc. Single Specialty CurrentSince Sep 1, 2021 Accepting new patients

Locations

1025 Michigan Ave
Ste 15
Logansport, IN 46947
Phone (574) 753-9000

1201 Michigan Ave
Ste 270
Logansport, IN 46947
Phone (574) 722-4921

3400 E Market St
Logansport, IN 46947
Phone (574) 722-9633

1101 Michigan Ave
Logansport, IN 46947
Phone (574) 753-1475

Organizations & group practices 2

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 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": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1649840521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 N 3RD ST",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471010",
            "telephone_number": "765-860-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471528",
            "telephone_number": "574-753-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "CHERYL",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-01",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28168027A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logansport, IN

Sources for this page

Verify at the official NPI Registry.