Individual provider Active NPI

Denese Davis

  • Nurse Practitioner
  • Kokomo, IN
National Provider Identifier
1770258147
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71011408A Issued in IN
Practice address
3500 S Lafountain St
Kokomo, IN 46902-3803
Phone
(765) 776-3500
NPI assigned
Aug 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71011408A IN Primary

Addresses

Primary practice location

3500 S Lafountain St
Kokomo, IN 46902-3803

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890
Phone (317) 621-7584

Other identifiers 3

IdentifierTypeStateIssuer
300054050MedicaidIN
Q00265548OtherINRAILROAD MEDICARE
266180J55OtherININDIV MEDICARE PTAN

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
I20210827002192 IN Practitioner - Nurse Practitioner 3870998974 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians
Community Physician Network Specialty Care LLCGroup PAC ID 9931697265, 260 clinicians

Practice addresses (Care Compare)

3500 S Lafountain St
Kokomo, IN 46902-3803
Phone (765) 453-8571

8075 N Shadeland Ave
Indianapolis, IN 46250-2693
Phone (317) 621-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71011408AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Aug 26, 2021 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Aug 26, 2021 Accepting new patients
Community Physician Network Specialty Care LLC CurrentSince Nov 24, 2025 Accepting new patients

Locations

5918 Reliable Pkwy
Chicago, IL 60686

5819 Reliable Pkwy
Chicago, IL 60686

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000

3500 S Lafountain St
Kokomo, IN 46902
Phone (765) 453-0702

Interoperability endpoints

  • Direct secure messaging: ddavis169321@ecommunitydirect.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 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": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1770258147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890",
            "telephone_number": "317-621-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S LAFOUNTAIN ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023803",
            "telephone_number": "765-776-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DENESE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-09",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71011408A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300054050",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "Q00265548",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIV MEDICARE PTAN",
            "identifier": "266180J55",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.