Individual provider Active NPI

Jennifer Jean Loop-Miller, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1730698267
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71007555A Issued in IN
Practice address
707 N Michigan St Ste 400
South Bend, IN 46601-1071
Phone
(574) 647-8470
Fax
(574) 647-8524
NPI assigned
Sep 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71007555A IN Primary

Addresses

Primary practice location

707 N Michigan St Ste 400
South Bend, IN 46601-1071

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other practice location 1

5314 Lincolnway E
Mishawaka, IN 46544-4249
Phone (574) 256-9032

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address LOOP-MILLER@mybeacon.cernerdirect.com

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
I20171206000823 IN Practitioner - Nurse Practitioner 0840557450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

707 N Michigan St
400 BMG Behavioral Health South Bend
South Bend, IN 46601-1071
Phone (574) 647-8470

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Dec 31, 2017 Accepting new patients
Beacon Medical Group, Inc. Psychiatric/Mental Health CurrentSince Dec 31, 2017 Accepting new patients

Locations

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

900 I St
Laporte, IN 46350
Phone (219) 324-1670

5314 Lincolnway E
Mishawaka, IN 46544
Phone (574) 256-9032

707 N Michigan St
Ste 400
South Bend, IN 46601
Phone (574) 647-4500

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

Interoperability endpoints

  • Direct secure messaging: loop-miller@mybeacon.cernerdirect.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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1730698267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N MICHIGAN ST STE 400",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011071",
            "telephone_number": "574-647-8470",
            "fax_number": "574-647-8524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5314 Lincolnway E",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465444249",
            "country_code": "US",
            "telephone_number": "574-256-9032",
            "fax_number": "574-256-9049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOOP-MILLER",
        "first_name": "JENNIFER",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71007555A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LOOP-MILLER@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "707 N Michigan St Ste 400",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.