Keona Chantel Davis

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71010690A Issued in IN

Practice address

31 Sibley St Ste A31E
Hammond, IN 46320-1725

Phone

(219) 802-8800

Fax

(219) 802-8801

NPI assigned

Dec 11, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN, IL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Express Care 4 LLCGroup PAC ID 4284909615, 64 clinicians

Midwest Express Care, IncGroup PAC ID 5193957595, 31 clinicians

Nwi Urgent Care, LLCGroup PAC ID 7618142977, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Nwi Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Munster, IN
  • NPI 1043596703
  Medicare reassignment Care Compare group NPD
• Midwest Express Care 4 LLC

  dba Midwest Express Clinics

  • Urgent Care Clinic/Center
  • Hammond, IN
  • NPI 1629502810
  Medicare reassignment Care Compare group
• Midwest Express Care, Inc

  • Urgent Care Clinic/Center
  • Schererville, IN
  • NPI 1942642848
  Medicare reassignment Care Compare group
• Midwest Express Care 2, Inc

  • Urgent Care Clinic/Center
  • Willowbrook, IL
  • NPI 1548692890
  Medicare reassignment
• The Methodist Hospitals, Inc

  dba Methodist Northlake Physicians

  • Internal Medicine Physician
  • Gary, IN
  • NPI 1720290349
  NPD (past)

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1881290005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 SIBLEY ST STE A31E",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463201725",
            "telephone_number": "219-802-8800",
            "fax_number": "219-802-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 SIBLEY ST STE A31E",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463201725",
            "telephone_number": "219-802-8800",
            "fax_number": "219-802-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KEONA",
        "middle_name": "CHANTEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-11",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71010690A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Jonas Damasius, PHARMD
• Claudette R Dandridge, M.D.
• Latecha Daniels
• Ronald Eugene Daulton Jr., D.C.
• Judy Davern, MSW
• Martha Davis, PHARMD
• Rose Davis, MA
• Shana Richelle Sarah Davis, C.D.
• Destini Dawson, CCC-SLP
• F K Deal, RPH

• Family Nurse Practitioner in Hammond, IN
• Providers in Hammond, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.