Individual provider Active NPI

Elizabeth M Marcotte, FNP

  • Family Nurse Practitioner
  • Portage, IN
National Provider Identifier
1740595495
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71003330A Issued in IN
Practice address
6050 Sterling Creek Rd
Portage, IN 46368-7752
Phone
(219) 763-8112
Fax
(219) 764-5380
NPI assigned
Aug 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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 71003330A IN Primary

Addresses

Primary practice location

6050 Sterling Creek Rd
Portage, IN 46368-7752

Mailing address

PO Box 1430
Portage, IN 46368-9230
Phone (219) 763-8112

Other identifiers 1

IdentifierTypeStateIssuer
201037280MedicaidIN

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
I20130703000143 IN Order and Referring Only - Nurse Practitioner 4183864739

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71003330AINMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: elizabeth.marcotte.p1@direct.northshorehealth.nextgenshare.com

NPI Registry JSON

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1740595495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1430",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463689230",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 STERLING CREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463687752",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCOTTE",
        "first_name": "ELIZABETH",
        "middle_name": "M",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-18",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003330A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201037280",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

Verify at the official NPI Registry.