Michelle E Mastin, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

1799 Issued in AL

Practice address

3900 Washington Ave # 100
Evansville, IN 47714-0550

Phone

(812) 485-6694

NPI assigned

May 18, 2006

Last updated

Aug 29, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Networks

• IL PPO Downstate
• KY PPO
• IL HMO C-SNP
• KY PPO C-SNP
• devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
• OH PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Vincent Pediatric Subspecialties

  • Pediatrics Physician
  • Indianapolis, IN
  • NPI 1013967736
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1003869116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 WASHINGTON AVE # 100",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 WASHINGTON AVE # 100",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140550",
            "telephone_number": "812-485-6694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 7th Ave S",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352331711",
            "country_code": "US",
            "telephone_number": "205-638-9461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASTIN",
        "first_name": "MICHELLE",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6301012872",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "AL",
            "license": "1799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PERSONAL PIN",
            "identifier": "P108974770",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Maserejian, MD
• Abigail Anne Mason, LCSW
• Megan Elizabeth Massie, RDN
• Pamela Lou Massie, MSW
• Kaitlin Paige Masterson, MS, OTR/L
• Lacey Kristin Matheis, MSN, NP-C
• Heather Bennett Matheson, MD
• Natasha Elizabeth Mathew, DO
• Devvy Mathews
• Anna Frances Mathis, RBT

• Clinical Child & Adolescent Psychologist in Evansville, IN
• Providers in Evansville, IN by specialty
• Clinical Child & Adolescent Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.