Individual provider Active NPI

Pamela Nubong

  • Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1891436481
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71012450A Issued in IN
Practice address
602 N High School Rd
Indianapolis, IN 46214-3694
Phone
(317) 291-1211
NPI assigned
Apr 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F12210302 IN
Nurse Practitioner 363L00000X 71012450A IN Primary

Addresses

Primary practice location

602 N High School Rd
Indianapolis, IN 46214-3694

Mailing address

602 N High School Rd
Indianapolis, IN 46214-3694

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
I20230706000528 IN Practitioner - Nurse Practitioner 3779942925 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

Practice addresses (Care Compare)

150 W Market St
Suite 400
Indianapolis, IN 46204-2810
Phone (855) 743-2247

8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71012450AINMDNurse Practitioner
F12210302INMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eventus Ecs, Inc Nurse Practitioner CurrentSince Dec 19, 2024 Accepting new patients
Eventus Ecs - Kentucky, PLLC Nurse Practitioner CurrentSince Nov 1, 2025 Accepting new patients
Eventus WH Midwest Care, LLC Nurse Practitioner CurrentSince Oct 1, 2025 Accepting new patients
Extended Care Specialists, Inc Nurse Practitioner CurrentSince Apr 1, 2024 Accepting new patients

Locations

2100 Midway St
Columbus, IN 47201
Phone 3178181240225

3512 Stellhorn Rd
Fort Wayne, IN 46815

3815 River Crossing Pkwy
Ste 100
Indianapolis, IN 46240
Phone (317) 218-3479

150 W Market St
Ste 400
Indianapolis, IN 46204

8398 Mississippi St
Fl 2
Merrillville, IN 46410

Organizations & group practices 4

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": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1891436481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 N HIGH SCHOOL RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462143694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N HIGH SCHOOL RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462143694",
            "telephone_number": "317-291-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUBONG",
        "first_name": "PAMELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "F12210302",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71012450A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.