Individual provider Active NPI

Nicolette Angela Kruzich, PA-C

  • Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1861297707
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
8111 S Emerson Ave
Indianapolis, IN 46237-8601
Phone
(317) 528-5000
NPI assigned
Feb 14, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X IN Primary

Addresses

Primary practice location

8111 S Emerson Ave
Indianapolis, IN 46237-8601

Mailing address

21041 Oak Ridge Rd
Sheridan, IN 46069-9720
Phone (847) 363-8677

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
I20250423000380 IN Practitioner - Physician Assistant 3577088566 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

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": "1739491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1861297707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21041 OAK RIDGE RD",
            "city": "SHERIDAN",
            "state": "IN",
            "postal_code": "460699720",
            "telephone_number": "847-363-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8111 S EMERSON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378601",
            "telephone_number": "317-528-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUZICH",
        "first_name": "NICOLETTE",
        "middle_name": "ANGELA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-14",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.