JACQUELINE LEE HENRY APRN-NP
NPI 1063239846
Nurse Practitioner - Family in South Bend, IN
About Jacqueline Lee Henry Aprn-np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUELINE LEE HENRY APRN-NP (NPI 1063239846) is an individual family provider in South Bend, Indiana, licensed in Oregon (10033768) and active in the NPI registry since September 2024. She is enrolled in Medicare PECOS, is affiliated with St Charles Medical Center - Bend, and is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jacqueline Lee Henry Aprn-np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jacqueline Henry reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
South Bend, IN 46617
- Reassigned Medicare billing, Indiana enrollment
- 211 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
St Charles Medical Center - Bend
Acute Care Hospitals · Bend, ORPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 46635 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SOUTH BEND, IN 46635
SOUTH BEND, IN 46635
SOUTH BEND, IN 46635
SOUTH BEND, IN 46635
SOUTH BEND, IN 46635
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jacqueline Henry's NPI number?
The NPI number for Jacqueline Henry is 1063239846. It was assigned to this individual provider in the NPPES registry on September 24, 2024. The provider is also known as Jacqueline Lee Michuda Aprn-Np.
Where is Jacqueline Henry located?
Jacqueline Henry practices at 6301 University Commons, South Bend, IN 46635. The listed phone number is (574) 251-1210.
What is Jacqueline Henry's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Jacqueline Henry enrolled in Medicare?
Yes. Jacqueline Henry is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jacqueline Henry's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Henry reassigns Medicare benefits to The South Bend Clinic LLC (South Bend, IN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacqueline Henry's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jacqueline Henry accept?
Health plans from Anthem Blue Cross and Blue Shield, CareSource and Moda Health Plan, Inc. list Jacqueline Henry as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Jacqueline Henry affiliated with any hospitals?
According to CMS data, Jacqueline Henry is affiliated with St Charles Medical Center - Bend.
When was this NPI record last updated?
The NPPES record for Jacqueline Henry was last updated on October 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jacqueline Lee Henry, APRN-NP · NPI 1063239846
Family physician in South Bend, Indiana. Individual provider, active in the CMS NPPES registry since September 24, 2024.
## Identity
- **NPI:** 1063239846 (Entity type: Individual)
- **Enumerated:** September 24, 2024
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 10033768 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 6301 UNIVERSITY COMMONS, South Bend, IN 46635-1571
- **Phone:** (574) 251-1210 · **Fax:** (574) 232-0741
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** The South Bend Clinic LLC (NPI 1073680419, South Bend, IN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** October 7, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1063239846) · Data from the CMS NPPES public registry.