Jodi Bult, N.P.
Individual provider Active NPI Adult Health Nurse Practitioner · Dyer, IN
NPI 1669447900 · NPPES record last updated Apr 8, 2021
Key facts
- NPI
- 1669447900
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 071004325A (IN)
- Practice address
- 15900 W 101St Ave
Dyer, IN 46311-3065 - Phone
- (219) 365-6333
- Fax
- (219) 365-8291
- NPI assigned
- Feb 21, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Marcotte Medical Group PC
Practice addresses (Care Compare)
15900 W 101St Ave
Dyer, IN 46311-3065
Phone (219) 365-6333
Hospital & facility affiliations
- Northwestern Medicine Central Dupage Hospital
- Community Hospital
- Franciscan Health Dyer
- Franciscan Health Crown Point
- Franciscan Health Munster
- Powers Health Rehabilitation Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130617000142 | IN | Practitioner - Nurse Practitioner | 4183604176 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071004325A | IN | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marcotte Medical Group, PC | Current |
Accepting new patients |
Locations
15900 W 101st Ave
Dyer, IN 46311
Phone (219) 365-6333
15900 W 101st Ave
#0
Dyer, IN 46311
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EBFGAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 071004325A | IN | Yes |
Addresses
Primary practice location
15900 W 101St Ave
Dyer, IN 46311-3065
Mailing address
15900 W 101St Ave
Dyer, IN 46311-3065
Phone (219) 365-6333
Other practice location 1
16000 W 101st Ave
Dyer, IN 46311
Phone (219) 365-6333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200424880A | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jodi.bult@mmgsc.eclinicaldirect.com | Direct |
Other providers in Dyer, IN
- Brilliant Minds LLC
- Katherine Marie Brkljacic
- Jake S Brown
- Satara Brown
- Erica L Bucholtz
- Tanya D Burk-Willson
- Erin Elizabeth Burrell
- C.L.O. Psychological, Serv.
- Timothy Caballero
- Cannan Healthcare Services & Staffing Inc
All providers in Dyer, IN · Adult Health Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.