NPIMap

Individual provider Active NPI

Teresa Templin, NP

  • Family Nurse Practitioner
  • Converse, IN
National Provider Identifier
1750362406
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71001211A Issued in IN
Practice address
308 N Jefferson St
Converse, IN 46919
Phone
(765) 660-7870
Fax
(765) 395-5128
NPI assigned
Nov 9, 2005
Last updated
Oct 19, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 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 71001211A IN Primary

Addresses

Primary practice location

308 N Jefferson St
Converse, IN 46919

Mailing address

330 North Wabash Ave
Suite G20
Marion, IN 46952-2600
Phone (765) 660-7616

Other identifiers 2

IdentifierTypeStateIssuer
000000321906OtherINANTHEM BCBS
200420710MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address teresa.templin@mgh.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100618000187 IN Practitioner - Nurse Practitioner 8820128812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marion General HospitalGroup PAC ID 9133023625, 115 clinicians

Practice addresses (Care Compare)

4781 Kaybee Dr
Gas City, IN 46933-6607
Phone (765) 660-7840

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.82 of 100Reported as group
Quality
71.45
Promoting interoperability
100
Improvement activities
40
Cost
75.59

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Marion General Hospital CurrentSince Mar 24, 2003 Accepting new patients
Marion General Hospital CurrentSince Mar 24, 2003 Accepting new patients
Earnest Associates Inc Past Accepting new patients

Locations

4781 Kaybee Dr
Gas City, IN 46933
Phone (765) 660-7840

119 S Washington St
Marion, IN 46952
Phone (765) 660-7440

330 N Wabash Ave
Ste G-20
Marion, IN 46952
Phone (765) 660-7600

441 N Wabash Ave
Marion, IN 46952
Phone (219) 482-4577

Interoperability endpoints

  • Direct secure messaging: teresa.templin@mgh.eclinicaldirectplus.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 8

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1750362406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 NORTH WABASH AVE",
            "address_2": "SUITE G20",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522600",
            "telephone_number": "765-660-7616",
            "fax_number": "765-651-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N JEFFERSON ST",
            "city": "CONVERSE",
            "state": "IN",
            "postal_code": "46919",
            "telephone_number": "765-660-7870",
            "fax_number": "765-395-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEMPLIN",
        "first_name": "TERESA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71001211A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000321906",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200420710",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "teresa.templin@mgh.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "308 N Jefferson St",
            "city": "Converse",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Converse, IN

Sources for this page

Verify at the official NPI Registry.