Jacob C Shively, in Fort Wayne, IN - Medicare Nurse Practitioner

Jacob C Shively, is a medicare enrolled "Nurse Practitioner" in Fort Wayne, Indiana. His current practice location is 11104 Parkview Circle Dr Ste 330, Fort Wayne, Indiana. You can reach out to his office (for appointments etc.) via phone at (260) 494-3484.

Jacob C Shively is licensed to practice in Indiana (license number 71012742A) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1215672928.

Contact Information

	Jacob C Shively,
	11104 Parkview Circle Dr Ste 330, Fort Wayne, IN 46845-1674
	(260) 494-3484
	(260) 969-0188

Map and Direction

Provider's Profile

Full Name	Jacob C Shively
Gender	Male
Speciality	Nurse Practitioner
Location	11104 Parkview Circle Dr Ste 330, Fort Wayne, Indiana
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1215672928
Provider Enumeration Date: 04/28/2022
Last Update Date: 11/01/2023

Medicare PECOS Information:

PECOS PAC ID: 8628447240
Enrollment ID: I20221202002397

Medical Identifiers

Medical identifiers for Jacob C Shively such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1215672928	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	71012742A (Indiana)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacob C Shively allows following entities to bill medicare on his behalf.

Entity Name	Parkview Health System Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1932130952 PECOS PAC ID: 2163336967 Enrollment ID: O20031117000288

Entity Name	Nephrology Associates Of Northern Indiana Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1578505814 PECOS PAC ID: 8921033440 Enrollment ID: O20051003000799

Entity Name	Nephrology Associates Of Northern Illinois Ltd
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1124069182 PECOS PAC ID: 2163328675 Enrollment ID: O20170705000259

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacob C Shively is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jacob C Shively, 120 W 22nd St Ste 200, Oak Brook, IL 60523-1563 Ph: (630) 573-5000	Jacob C Shively, 11104 Parkview Circle Dr Ste 330, Fort Wayne, IN 46845-1674 Ph: (260) 494-3484

Reviews and Comments

Nurse Practitioner Nurses in Fort Wayne, IN

Carrie Jean Boots, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 7910 W Jefferson Blvd Ste 108, Fort Wayne, IN 46804 Phone: 260-484-8830 Fax: 260-483-1911
Mrs. Jamie Lynn Peppler, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5910 Homestead Rd, Fort Wayne, IN 46814 Phone: 260-435-3272 Fax: 260-435-3275
Luann Deafenbaugh, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 7910 W Jefferson Blvd Ste 108, Fort Wayne, IN 46804 Phone: 260-436-0800 Fax: 260-483-1911
Stephanie Ann Clouse, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 7910 W Jefferson Blvd Ste 120, Fort Wayne, IN 46804 Phone: 260-435-7612 Fax: 260-435-7672
Cathy S Walker, FNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1234 E. Dupont Rd., Suite 6, Fort Wayne, IN 46825 Phone: 260-480-2600 Fax: 260-496-8077
Cara E Walker, APN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 11123 Parkview Plaza Dr, Suite 101, Fort Wayne, IN 46845 Phone: 260-422-7455
Kara Yackee, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3909 New Vision Dr, Fort Wayne, IN 46845 Phone: 260-469-6610 Fax: 260-969-3065

Jacob C Shively, - Medicare Nurse Practitioner in Fort Wayne, IN