Individual provider Active NPI

Charisse L Prall, NP

  • Family Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1699292722
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71007582A Issued in IN
Practice address
11143 Parkview Plaza Dr Ste 100
Fort Wayne, IN 46845-1728
Phone
(260) 484-8830
NPI assigned
Aug 29, 2017
Last updated
Dec 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71007582A IN Primary
Registered Nurse 163W00000X 28173869A IN

Addresses

Primary practice location

11143 Parkview Plaza Dr Ste 100
Fort Wayne, IN 46845-1728

Mailing address

11143 Parkview Plaza Dr Ste 100
Fort Wayne, IN 46845-1728

Other practice location 1

2117 W Lexington Ave
Elkhart, IN 46514-1423
Phone (574) 296-3444

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
I20171101000175 IN Practitioner - Nurse Practitioner 6800162140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Oncology Partners PAGroup PAC ID 0042569758, 377 clinicians

Practice addresses (Care Compare)

2117 W Lexington Ave
Elkhart, IN 46514-1423
Phone (574) 296-3444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28173869AINMDRegistered Nurse
71007582AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Indiana, LLC CurrentSince Apr 1, 2025 Accepting new patients
American Oncology Partners PA CurrentSince Feb 9, 2026 Accepting new patients
Privia Medical Group Indiana, LLC Family Current Accepting new patients

Locations

2117 W Lexington Ave
Elkhart, IN 46514
Phone (574) 296-3255

303 S Nappanee St
Elkhart, IN 46514

7910 W Jefferson Blvd
Ste 108
Fort Wayne, IN 46804
Phone (219) 484-8830

Interoperability endpoints

  • Direct secure messaging: charisse.prall.1@31626.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1503964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1699292722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11143 PARKVIEW PLAZA DR STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11143 PARKVIEW PLAZA DR STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451728",
            "telephone_number": "260-484-8830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2117 W Lexington Ave",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465141423",
            "country_code": "US",
            "telephone_number": "574-296-3444",
            "fax_number": "574-296-3328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRALL",
        "first_name": "CHARISSE",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-29",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007582A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28173869A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.