OrganizationActive
Northeast Internal Medicine
NPI 1366859779 · Primary Care Nurse Practitioner · Lagrange, IN
Provider details
- NPI number
- 1366859779
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Tara Gilmore, Business Office Manager(260) 463-2133
- License
- 71004993A (IN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(80/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2500 N Detroit St
Lagrange, IN 46761-1158
Phone: (260) 463-2133
Street-level locationGet directions
Mailing address
Po Box 236
Lagrange, IN 46761-0236
Additional practice locations (1)
- 610 N Sawyer RdKendallville, IN 46755-2566Phone: (260) 347-5592Fax: (260) 347-5155
Registry dates
- Enumerated
- 2014-07-17
- Last updated
- 2019-02-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.