Individual provider Active NPI

Mary Teresa Folk

  • Gerontology Nurse Practitioner
  • Crown Point, IN
National Provider Identifier
1801456165
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71009310A Issued in IN
Practice address
2100 N Main St Ste 304
Crown Point, IN 46307-1877
Phone
(574) 546-1900
Fax
(574) 546-1999
NPI assigned
Jun 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 3013448 KY
Gerontology Nurse Practitioner 363LG0600X 71009310A IN Primary

Addresses

Primary practice location

2100 N Main St Ste 304
Crown Point, IN 46307-1877

Mailing address

PO Box 10299
Fort Wayne, IN 46851-0299
Phone (574) 546-1900

Other practice location 1

101 S 5th St Ste 2500
Louisville, KY 40202-3066
Phone (574) 546-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190912001357 IN Practitioner - Nurse Practitioner 6103155320 Reassigns benefits to 1 organization
I20200518001795 KY Practitioner - Nurse Practitioner 6103155320 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.06 of 100Reported as group
Quality
80.07
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71009310AINMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neurology and Pain Management Associates PC Gerontology CurrentSince Sep 15, 2019 Accepting new patients

Locations

601 W County Road 200 S
New Castle, IN 47362
Phone (765) 529-5796

220 W Colfax Ave
Ste 400
South Bend, IN 46601
Phone (574) 255-4976

20 John Kissinger Dr
Wabash, IN 46992
Phone (260) 274-0444

851 Kimsey Ln
Henderson, KY 42420
Phone (270) 295-6450

101 S 5th St
Ste 2500
Louisville, KY 40202

312 S 4th St
Ste 700
Louisville, KY 40202
Phone (502) 628-5023

50 Sanderson Ln
Coldwater, MI 49036
Phone (517) 279-9587

41000 W 13 Mile Rd
Novi, MI 48377
Phone (248) 360-4327

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595548800000",
    "number": "1801456165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10299",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468510299",
            "telephone_number": "574-546-1900",
            "fax_number": "574-546-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N MAIN ST STE 304",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463071877",
            "telephone_number": "574-546-1900",
            "fax_number": "574-546-1999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 S 5th St Ste 2500",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402023066",
            "country_code": "US",
            "telephone_number": "574-546-1900",
            "fax_number": "574-546-1999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOLK",
        "first_name": "MARY",
        "middle_name": "TERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-19",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KY",
            "license": "3013448",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71009310A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.