Individual ProviderJean D. RossNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2516 E Dupont Rd, Fort Wayne, IN 46825-1608(260) 434-6076(260) 479-3514PECOS EnrollmentBased on the most recent information from CMS, provider Jean D. Ross does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1104862382Provider TypeIndividualFull NameRoss, Jean D.CredentialNPGenderFemaleSole ProprietorNoEnumeration Date6/22/2006Last Updated1/3/2017Contact InformationPractice LocationPractice Address2516 E Dupont Rd, Fort Wayne, IN 46825-1608Phone(260) 434-6076Fax(260) 489-0833Mailing LocationMailing Address6920 Pointe Inverness Way Ste 200, Medpartners, Attn: Barb Copeland, Fort Wayne, IN 46804-7934Phone(260) 479-3514Fax(260) 479-3520Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71000818AIndianaProvider IdentifiersIDDescriptionIssuerID200290830DescriptionMedicaidIssuerUnlistedIndianaID000000611224DescriptionOtherIssuerANTHEMIndiana