Individual provider Active NPI

Denise M Alexander, NP

  • Nurse Practitioner
  • Bloomington, IN
National Provider Identifier
1821615485
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71010281A Issued in IN
Practice address
3050 N Lintel Drive
Bloomington, IN 47404-8975
Phone
(812) 336-2815
NPI assigned
Jun 30, 2020
Last updated
Mar 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 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 71010281A IN Primary

Addresses

Primary practice location

3050 N Lintel Drive
Bloomington, IN 47404-8975

Mailing address

21 Eastbrook Bend, Ste 218
Peachtree City, GA 30269-1546
Phone (678) 967-5599

Other identifiers 1

IdentifierTypeStateIssuer
300041968MedicaidIN

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
I20200910002782 IN Practitioner - Nurse Practitioner 1951729789 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impact Physician Group Indiana LLCGroup PAC ID 6608111026, 25 clinicians

Practice addresses (Care Compare)

13219 N Meridian St
Carmel, IN 46032-5480
Phone (847) 821-6828

3050 N Lintel Dr
Bloomington, IN 47404-8945
Phone (812) 336-2815

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71010281AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vascular Center & Vein Clinic of Southern Indiana CurrentSince Aug 19, 2020 Accepting new patients
Impact Physician Group, Indiana LLC CurrentSince Dec 1, 2021 Accepting new patients

Locations

21 Eastbrook Bnd
Ste 218
Peachtree Cty, GA 30269
Phone (260) 407-8007

3050 N Lintel Dr
Bloomington, IN 47404
Phone (812) 336-2815

815 W 2nd St
Bloomington, IN 47403
Phone (812) 336-4947

13219 N Meridian St
Carmel, IN 46032
Phone (765) 751-5253

Organizations & group practices 2

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 2

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": "1593475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1821615485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BEND, STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "678-967-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 N LINTEL DRIVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474048975",
            "telephone_number": "812-336-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALEXANDER",
        "first_name": "DENISE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-30",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71010281A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300041968",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.