Autumn Marie Hanna, PA
Individual provider Active NPI Physician Assistant · South Bend, IN
NPI 1003677964 · NPPES record last updated Aug 19, 2025
Key facts
- NPI
- 1003677964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 211 N Eddy St
South Bend, IN 46617-2808 - Phone
- (574) 234-8161
- NPI assigned
- Jan 18, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- The South Bend Clinic LLC
Practice addresses (Care Compare)
211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 234-8161
Hospital & facility affiliations
- Aunova Home Care LLC
- Saint Joseph Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240516002469 | IN | Practitioner - Physician Assistant | 4981045291 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The South Bend Clinic, LLC | Current |
Accepting new patients | |
| The South Bend Clinic LLC | Current | Accepting new patients |
Locations
211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331
Interoperability endpoints
- aaxline267972@dulyhealthandcare.direct-ci.com
- https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
211 N Eddy St
South Bend, IN 46617-2808
Mailing address
26621 Hamilton St
Edwardsburg, MI 49112-9691
Phone (574) 855-9892
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300090479 | Medicaid | IN |
Other names
- Autumn Axline
Other providers in South Bend, IN
- Janet Elizabeth Hanff
- Camden Edwin Jenkins Hanks
- Shardane Hanks
- Kathryn A. Hanlon
- Alexander David Hann
- Leah Malinda Amstutz Hansel
- Alissa Hansen
- Taylor Hansen
- Laura A Happ
- Happy Home Senior Care, LLC
All providers in South Bend, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.