Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jeromy Michael Shoup, NP

Individual provider Family Nurse Practitioner · NPI 1053960120

Jeromy Michael Shoup, NP is a Nurse Practitioner in Indianapolis, Indiana. Qualified in 2019, 7 years ago. Practices with Lifespan Advanced Care LLC, a 15-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
7
Licensed in
IN
In the registry since
2019
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

1500 N Ritter Ave
Indianapolis, IN 46219-3027
Phone: (317) 355-1411
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 517 N Concord Rd, Crawfordsville, IN 47933-9002 — (317) 517-2339

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 71009462 (IN)

Record details

NPI number1053960120
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorNo
NPI enumeratedSeptember 10, 2019
Last updated in NPPESMarch 5, 2024
Certification dateMarch 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Lifespan Advanced Care Llc — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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