Individual provider Active NPI

Jessica Grace Glassman, NP

  • Family Nurse Practitioner
  • Mishawaka, IN
National Provider Identifier
1992054183
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28174099A Issued in IN
Practice address
611 E Douglas Rd Ste 305
Mishawaka, IN 46545-1467
Phone
(574) 335-6450
Fax
(574) 335-0643
NPI assigned
Sep 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28174099A IN Primary

Addresses

Primary practice location

611 E Douglas Rd Ste 305
Mishawaka, IN 46545-1467

Mailing address

707 Cedar St Ste 405
South Bend, IN 46617-2059

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
I20130122000030 IN Practitioner - Nurse Practitioner 9032362280 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Joseph Regional Medical Center IncGroup PAC ID 8325950843, 137 clinicians

Practice addresses (Care Compare)

611 E Douglas Rd
305 Neurology
Mishawaka, IN 46545-1467
Phone (574) 335-6450

Hospital & facility affiliations

  • Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
  • Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076
  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28174099AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc CurrentSince Oct 12, 2020 Accepting new patients
Saint Joseph Regional Medical Center, Inc. CurrentSince Oct 12, 2020 Accepting new patients
Saint Joseph Regional Medical Center, Inc. Family CurrentSince Oct 12, 2020 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc CurrentSince Oct 12, 2020 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. CurrentSince Oct 12, 2020 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Family Current Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc Current Accepting new patients

Locations

611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232

611 E Douglas Rd
Ste 305
Mishawaka, IN 46545
Phone (574) 335-6450

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

510 W Adams St
Ste 150
Plymouth, IN 46563
Phone (574) 335-3987

707 Cedar St
Ste 405
South Bend, IN 46617

707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328

616 E 13th St
Winamac, IN 46996
Phone (574) 946-2100

Interoperability endpoints

  • Direct secure messaging: jglassman1147810@direct.trinity-health.org

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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": "1346630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1992054183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 405",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 305",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451467",
            "telephone_number": "574-335-6450",
            "fax_number": "574-335-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASSMAN",
        "first_name": "JESSICA",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-03",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28174099A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.