Individual provider Active NPI

Regina Nelson

  • Family Nurse Practitioner
  • Merrillville, IN
National Provider Identifier
1679966030
Registry record updated Apr 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71005745A Issued in IN
Practice address
3147 W 65TH Ave
Merrillville, IN 46410-2978
Phone
(219) 487-5031
NPI assigned
Mar 10, 2015
Last updated
Apr 21, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71005745A IN Primary

Addresses

Primary practice location

3147 W 65TH Ave
Merrillville, IN 46410-2978

Mailing address

3147 W 65TH Ave
Merrillville, IN 46410-2978
Phone (219) 487-5031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150617001238 IL Practitioner - Nurse Practitioner 9830400811 Reassigns benefits to 1 organization
I20150930001099 IN Practitioner - Nurse Practitioner 9830400811 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1300 Vale Park Rd
Valparaiso, IN 46383-2722
Phone (219) 246-4396

1532 Calumet Ave
Dyer, IN 46311-1588
Phone (219) 515-4700

1555 S Main St
Crown Point, IN 46307-0114
Phone (219) 323-8700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71005745AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optimal Neuroscience Services LLC CurrentSince Sep 1, 2018 Accepting new patients
Theoria Medical CurrentSince Aug 4, 2024 Accepting new patients

Locations

4350 211th St
Ste 210A
Matteson, IL 60443
Phone (708) 200-0034

155 E Burks Dr
Bloomington, IN 47401
Phone (812) 332-4437

402 19th St
Tell City, IN 47586
Phone (812) 547-3427

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492732800000",
    "number": "1679966030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3147 W 65TH AVE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102978",
            "telephone_number": "219-487-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3147 W 65TH AVE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102978",
            "telephone_number": "219-487-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "REGINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-10",
        "last_updated": "2017-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71005745A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.