Individual provider Active NPI

Ashley R Mellott, NP

  • Nurse Practitioner
  • Evansville, IN
National Provider Identifier
1053084731
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71011507A Issued in IN
Practice address
545 S Boehne Camp Rd
Evansville, IN 47712-3703
Phone
(812) 429-1818
Fax
(812) 426-9564
NPI assigned
Jul 28, 2021
Last updated
Sep 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 28160499A IN
Nurse Practitioner 363L00000X 71011507A IN Primary

Addresses

Primary practice location

545 S Boehne Camp Rd
Evansville, IN 47712-3703

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 429-1818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210917001048 IN Practitioner - Nurse Practitioner 1658778667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

545 S Boehne Camp Rd
Evansville, IN 47712-3703
Phone (812) 429-1818

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28160499AINMDNurse Practitioner
71011507AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic Inc Nurse Practitioner CurrentSince Sep 12, 2021 Accepting new patients
Deaconess Clinic Inc. Nurse Practitioner Current Accepting new patients
Deaconess Clinic Inc. Nurse Practitioner CurrentSince Sep 12, 2021 Accepting new patients
Deaconess Clinic, Inc Nurse Practitioner Past Accepting new patients

Locations

120 SE 4th St
Evansville, IN 47708
Phone (812) 426-6638

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

545 S Boehne Camp Rd
Evansville, IN 47712
Phone (812) 402-1264

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

Interoperability endpoints

  • Direct secure messaging: amellott11550@direct.deaconess.com

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1053084731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-429-1818",
            "fax_number": "812-426-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 S BOEHNE CAMP RD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477123703",
            "telephone_number": "812-429-1818",
            "fax_number": "812-426-9564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLOTT",
        "first_name": "ASHLEY",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "28160499A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71011507A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.