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NWI MDVIP LLC
NPI 1538877972
Family Medicine in Crown Point, IN

Active since November 14, 2022CLIA 15D2277081 · Waiver
9150 E 109TH AVE STE 2B, CROWN POINT, IN 46307(219) 213-2947(219) 310-8175 Get Directions Write a Review

NPPES record last updated: November 14, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Nwi Mdvip Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NWI MDVIP LLC (NPI 1538877972) is a healthcare organization registered as a family medicine in Crown Point, Indiana and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through February 21, 2027 and lists Brent A Jacobus, Owner, as its authorized official.

NPPES Registry Identity

NPI1538877972
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameNWI MDVIP LLC
Location Address9150 E 109TH AVE STE 2BCrown Point, IN 46307-7686
Mailing Address9150 E 109th Ave Ste 2bCrown Point, IN 46307-7686 · (219) 306-0752
Phone(219) 213-2947
Fax(219) 310-8175
Organization SubpartNo
Authorized OfficialBrent A JacobusOwner · (219) 306-0752
Enumeration DateNovember 14, 2022
NPPES CertifiedNovember 14, 2022
✔ NPI 1538877972 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
9150 E 109TH AVE STE 2B, Crown Point, IN 46307
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Other Identifiers 2

Medicaid200380090IN
Medicaid100200720IN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2277081

Nwi Mdvip LLC · Crown Point, IN
Active · expires Feb 21, 2027
CLIA Number15D2277081
Laboratory TypePhysician Office
Certificate Effective DateFebruary 22, 2025
Certificate Expiration DateFebruary 21, 2027
Laboratory DirectorBrent A. Jacobus
Laboratory Phone(219) 312-2947
Laboratory LocationNwi Mdvip LLC9150 E 109th Ave Ste 2B, Crown Point, IN 46307
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REFUGE CLINIC, LLC
Family Medicine (Addiction Medicine)
9150 E 109TH AVE STE 2B
CROWN POINT, IN 46307
Lake County (219) 213-2947

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 Nwi Mdvip LLC's NPI number?

The NPI number for Nwi Mdvip LLC is 1538877972. It was assigned to this organization in the NPPES registry on November 14, 2022.

Where is Nwi Mdvip LLC located?

Nwi Mdvip LLC is located at 9150 E 109th Ave Ste 2B, Crown Point, IN 46307. The listed phone number is (219) 213-2947.

What is Nwi Mdvip LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Nwi Mdvip LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2277081) is associated with this NPI, valid through February 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Nwi Mdvip LLC was last updated on November 14, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.