JESSE R KOOISTRA (FNP) – Family Nurse Practitioner, NPI 1467251496
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,241 NURSE PRACTITIONER in IN
Provider Addresses for JESSE R KOOISTRA (FNP)
6920 POINTE INVERNESS WAY STE 200
FORT WAYNE, IN 468047934
Phone: (260) 479-3513
Type: Mailing
1500 PROVIDENT DR STE A
WARSAW, IN 465803297
Phone: (574) 372-7637
Type: Location
600 East Blvd
Elkhart, IN 465142483
Phone: (406) 468-5767
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2025-07-09
PECOS data refreshed: 2026-06-15
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250709001694 | I | Nurse Practitioner | IN | TBD |
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.
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 46804)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IN | |
| - | IN | |
| Physician Assistant | IN | |
| Nurse Practitioner | IN | |
| Physician Assistant | IN | |
| Family Practice | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| - | IN |
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