KRYSTAL ANTRIM (FNP) – Family Nurse Practitioner, NPI 1053191593

KRYSTAL ANTRIM (FNP) is a healthcare provider. based in Laporte, Indiana. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. F08211097 (IN). The NPI Number for KRYSTAL ANTRIM (FNP) is 1053191593

Main info

Female
5 Years Of Experience
Accepts Medicare Assignment
Name
KRYSTAL ANTRIM (FNP)
NPI
1053191593
Phone
(219) 575-6244
Address
401 NEWPORTE BLVD.
Enumeration Date
2 October 2023
Last Update Date
9 February 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2021 (5 years ago)
PAC ID
4486005220
Group Practice PAC ID
0446558357
Professional Enrollment ID
I20240105003098
Address ID
IN463607697MI3777XRDXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

8,192 NURSE PRACTITIONER in IN

Provider Addresses for KRYSTAL ANTRIM (FNP)

  • 401 NEWPORTE BLVD.

    LAPORTE, IN 46350

    Phone: (219) 575-6244

    Type: Mailing

  • 401 NEWPORTE BLVD

    LAPORTE, IN 46350

    Phone: (219) 575-6244

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $33.

Total Amount is formed as General ($33) + Research ($0) + Ownership ($0) = $33.

Last reported payment date: 2024-08-15 • Largest payer in this snapshot: Phathom Pharmaceuticals, Inc. ($18).

Total Amount

$33

General + Research + Ownership

Payments

2

Total payment records

General Amount

$33

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-15

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-01-05

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240105003098INurse PractitionerINTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 46350)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0446558357View full group profile
NameSpecialtyState
Cardiovascular Disease (Cardiology)WI
O P H T H A L M O L O G YIN
O B S T E T R I C S/ G Y N E C O L O G YIN
Interventional CardiologyTX
Nurse PractitionerIN
-IN
-IN
-IN
-IL
Physician AssistantCT

Reviews

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Frequently asked questions

What is KRYSTAL ANTRIM (FNP)'s NPI number?
KRYSTAL ANTRIM (FNP)'s NPI is 1053191593 — the number used across U.S. healthcare to identify this provider.
Is KRYSTAL ANTRIM (FNP) still an active registrant?
KRYSTAL ANTRIM (FNP) carries an active NPI according to the public dataset.
What kind of doctor is KRYSTAL ANTRIM (FNP)?
KRYSTAL ANTRIM (FNP) is associated with Family Nurse Practitioner in the directory — Clinical services aligned with this taxonomy classification.
Where in Indiana is KRYSTAL ANTRIM (FNP) registered?
Use Laporte, Indiana as the headline location for KRYSTAL ANTRIM (FNP) here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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