Stephanie Ann Fortman, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71016070A Issued in IN

Practice address

1311 W 96TH St
Indianapolis, IN 46260-1191

Phone

(765) 698-8192

NPI assigned

Jul 10, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mending Minds, LLCGroup PAC ID 4284037987, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24167/brand/1/csg/1/fhir/r4
• Direct secure messaging: stephanie.fortman.1@24167.direct.athenahealth.com

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.

• Mending Minds, LLC

  • Psychiatry Physician
  • Indianapolis, IN
  • NPI 1780258798
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1902643729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "CAMBRIDGE CITY",
            "state": "IN",
            "postal_code": "473270304",
            "telephone_number": "765-698-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 W 96TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601191",
            "telephone_number": "765-698-8192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTMAN",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28268154A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71016070A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tia Carmen Forthofer
• Saura Fortin Erazo, M.D.
• Jamie Fortino
• Matthew Fortino
• Debbie Fortman
• Sarah Nicole Fortna, MD
• Geoffrey Mark Fortner, M.D.
• Leanne M Fortner, M.D.
• Lawrence N. Fortress, D.D.S
• Jessica H. Fortunak, NP

• Psychiatric/Mental Health Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.