Individual provider Active NPI

Daydream Jamantoc De la Pena, FNP - C

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1861209611
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71016148A Issued in IN
Practice address
10122 E 10TH St Ste 220
Indianapolis, IN 46229-2664
Phone
(317) 355-2200
NPI assigned
Dec 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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 71016148A IN Primary

Addresses

Primary practice location

10122 E 10TH St Ste 220
Indianapolis, IN 46229-2664

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890

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
I20250127000190 IN Practitioner - Nurse Practitioner 4587193222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

10122 E 10TH St
Suite 220
Indianapolis, IN 46229-2664
Phone (317) 355-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71016148AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Feb 17, 2025 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Feb 17, 2025 Accepting new patients
Major Hospital Past Accepting new patients

Locations

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

10122 E 10th St
Ste 220
Indianapolis, IN 46229
Phone (317) 355-2200

10122 E 10th St
Indianapolis, IN 46229
Phone (317) 355-2132

Interoperability endpoints

  • Direct secure messaging: djamantoc485901@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": "1734307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1861209611",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 220",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664",
            "telephone_number": "317-355-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA PENA",
        "first_name": "DAYDREAM",
        "middle_name": "JAMANTOC",
        "credential": "FNP - C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-16",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71016148A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.