Individual provider Active NPI

Meredith Leilani Koontz

  • Acute Care Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1861053068
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
71009095A Issued in IN
Practice address
705 Riley Hospital Dr RM 1134
Indianapolis, IN 46202-5109
Phone
(317) 944-6102
NPI assigned
Jun 27, 2019
Last updated
Nov 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 71009095A IN Primary
Registered Nurse 163W00000X 28179551A IN

Addresses

Primary practice location

705 Riley Hospital Dr RM 1134
Indianapolis, IN 46202-5109

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other names 1

  • Meredith Leilani Magnetti Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkoontz2@direct.iuhealth.org

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
I20190727000353 IN Practitioner - Nurse Practitioner 5799011813 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28179551AINMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
University Family Physicians, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Iu Health Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
University Family Physicians, Inc. CurrentSince Aug 1, 2019 Accepting new patients

Locations

7216 Solutions Ctr
Chicago, IL 60677

1520 N Senate Ave
Indianapolis, IN 46202
Phone (317) 962-0857

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

705 Riley Hospital Dr
Rm 1134
Indianapolis, IN 46202
Phone (317) 944-6102

950 N Meridian St
Ste 500
Indianapolis, IN 46204
Phone (317) 962-4941

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.

NPI Registry JSON

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1861053068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 RILEY HOSPITAL DR RM 1134",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025109",
            "telephone_number": "317-944-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "MEREDITH",
        "middle_name": "LEILANI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-27",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "71009095A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28179551A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkoontz2@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "705 Riley Hospital Dr Rm 1134",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462025109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MEREDITH",
            "last_name": "MAGNETTI",
            "middle_name": "LEILANI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.