Provider Demographics
NPI:1639274848
Name:BLUME, JODI ANN HETTERMANN (PA-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ANN HETTERMANN
Last Name:BLUME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 S EAST ST
Mailing Address - Street 2:BUILDING A SUITE B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1939
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-9029
Practice Address - Street 1:5510 SOUTH EAST ST
Practice Address - Street 2:BUILDING A SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-228-2321
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000571A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000340579OtherANTHEM PROVIDER NUMBER
IN000000340579OtherUNICARE PROVIDER NUMBER
IN000000340579OtherANTHEM PROVIDER NUMBER
INP00226392Medicare ID - Type UnspecifiedMEDICARE RAILROAD
IN186950JMedicare ID - Type Unspecified