Individual provider Active NPI

Jerri Jakich-Ortiz, MS

  • Family Nurse Practitioner
  • Crown Point, IN
National Provider Identifier
1891028833
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71003055A Issued in IN
Practice address
2100 N Main St Ste 304
Crown Point, IN 46307-1877
Phone
(574) 546-1900
Fax
(574) 546-1999
NPI assigned
Sep 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 28090074A IN
Nurse Practitioner 363L00000X 71003055A IN
Family Nurse Practitioner 363LF0000X 71003055B IN
Family Nurse Practitioner 363LF0000X 71003055A IN Primary

Addresses

Primary practice location

2100 N Main St Ste 304
Crown Point, IN 46307-1877

Mailing address

PO Box 10299
Fort Wayne, IN 46851-0299
Phone (574) 546-1900

Other practice location 1

320 W 61st Ave
Hobart, IN 46342-6490
Phone (219) 947-6839

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
I20091124000595 IN Practitioner - Nurse Practitioner 6507905916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurology and Pain Management Associates PCGroup PAC ID 4486676095, 86 clinicians

Practice addresses (Care Compare)

2100 N Main St
Suite 304
Crown Point, IN 46307-1877
Phone (574) 546-1900

Merit-based Incentive Payment System (MIPS)

Final score
93.06 of 100Reported as group
Quality
80.07
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28090074AINMDRegistered Nurse
71003055BINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neurology and Pain Management Associates PC Nurse Practitioner CurrentSince Aug 1, 2018 Accepting new patients

Locations

601 W County Road 200 S
New Castle, IN 47362
Phone (765) 529-5796

20 John Kissinger Dr
Wabash, IN 46992
Phone (260) 274-0444

851 Kimsey Ln
Henderson, KY 42420
Phone (270) 295-6450

50 Sanderson Ln
Coldwater, MI 49036
Phone (517) 279-9587

41000 W 13 Mile Rd
Novi, MI 48377
Phone (248) 360-4327

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": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1891028833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10299",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468510299",
            "telephone_number": "574-546-1900",
            "fax_number": "574-546-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N MAIN ST STE 304",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463071877",
            "telephone_number": "574-546-1900",
            "fax_number": "574-546-1999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 W 61st Ave",
            "address_purpose": "LOCATION",
            "city": "Hobart",
            "state": "IN",
            "postal_code": "463426490",
            "country_code": "US",
            "telephone_number": "219-947-6839",
            "fax_number": "219-947-6839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAKICH-ORTIZ",
        "first_name": "JERRI",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-09",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28090074A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71003055A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003055B",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003055A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.