NPIMap

Individual provider Active NPI

Constantina C. Tucker, D.O.

  • Family Medicine Physician
  • Schererville, IN
National Provider Identifier
1861515447
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02004498A Issued in IN
Practice address
505 West Lincoln Hwy
Schererville, IN 46375-1554
Phone
(219) 311-3311
NPI assigned
Apr 9, 2007
Last updated
Aug 29, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101016610 MI
Family Medicine Physician 207Q00000X 02004498A IN Primary

Addresses

Primary practice location

505 West Lincoln Hwy
Schererville, IN 46375-1554

Mailing address

505 West Lincoln Hwy
Schererville, IN 46375-1554
Phone (219) 311-3311

Other identifiers 1

IdentifierTypeStateIssuer
036121455OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141028001231 IN Practitioner - Family Practice 6103992771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

505 W US Hwy 30
Schererville, IN 46375-2650
Phone (219) 322-3311

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02004498AINMDFamily Medicine Physician
5101016610MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc Family Medicine CurrentSince Sep 18, 2014 Accepting new patients
Osf Healthcare System Past Accepting new patients

Locations

8558 Broadway
Merrillville, IN 46410
Phone (219) 392-7084

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

505 W US Highway 30
Schererville, IN 46375
Phone (219) 322-3311

Interoperability endpoints

  • Direct secure messaging: ctucker60553@ssdirect.comhs.org

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 8

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": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1861515447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 WEST LINCOLN HWY",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463751554",
            "telephone_number": "219-311-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 WEST LINCOLN HWY",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463751554",
            "telephone_number": "219-311-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "CONSTANTINA",
        "middle_name": "C.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101016610",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004498A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036121455",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schererville, IN

Sources for this page

Verify at the official NPI Registry.