Individual provider Active NPI

Jessica Rose Allison, DO

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1992547640
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11023811A Issued in IN
Practice address
750 Broadway Ste 350
Fort Wayne, IN 46802-1412
Phone
(260) 423-2675
Fax
(260) 423-6621
NPI assigned
Jun 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11023811A IN Primary

Addresses

Primary practice location

750 Broadway Ste 350
Fort Wayne, IN 46802-1412

Mailing address

750 Broadway Ste 250
Fort Wayne, IN 46802-1412
Phone (260) 423-2675

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240620002885 IN Order and Referring Only - Family PracticePractitioner - Family Practice 8426591264

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Wayne Medical Education Program Family Medicine CurrentSince Sep 1, 2024 Accepting new patients

Locations

750 Broadway
Ste 250
Fort Wayne, IN 46802
Phone (260) 423-2675

750 Broadway
Ste 350
Fort Wayne, IN 46802
Phone (260) 423-2675

Interoperability endpoints

  • Direct secure messaging: jessica.allison@nhci.eclinicaldirectplus.com
  • Direct secure messaging: jessica.allison.1@17223.direct.athenahealth.com

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": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1992547640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 BROADWAY STE 250",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021412",
            "telephone_number": "260-423-2675",
            "fax_number": "260-423-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BROADWAY STE 350",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021412",
            "telephone_number": "260-423-2675",
            "fax_number": "260-423-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLISON",
        "first_name": "JESSICA",
        "middle_name": "ROSE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11023811A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.