Provider Demographics
NPI:1114196102
Name:HASSELL, AMY M (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:HASSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:OLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-225-3700
Practice Address - Fax:615-225-4741
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067361A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000667932OtherANTHEM
IN200986120Medicaid
INP01157068OtherRR MEDICARE PTAN
INM400044970Medicare PIN
INM400018514Medicare PIN
INP01157068OtherRR MEDICARE PTAN
M400026105Medicare PIN
INM400018511Medicare PIN
INM400018510Medicare PIN
INM400025667Medicare UPIN
INM400018515Medicare PIN
INM400033184Medicare PIN
INM400044902Medicare PIN
INM400046285Medicare PIN
INM400018516Medicare PIN
IN200986120Medicaid