NPIMap

Individual provider Active NPI

Sam Hansen, MD

  • Cardiovascular Disease Physician
  • Lafayette, IN
National Provider Identifier
1154397701
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
01054645A Issued in IN
Practice address
3900 St Francis Way Ste 205
Lafayette, IN 47905-4939
Phone
(765) 428-2500
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 01054645A IN Primary

Addresses

Primary practice location

3900 St Francis Way Ste 205
Lafayette, IN 47905-4939

Mailing address

3900 St Francis Way Ste 205
Lafayette, IN 47905-4939

Other identifiers 1

IdentifierTypeStateIssuer
200342990MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sam.hansen.1@7598.direct.athenahealth.com St. Vincent Medical Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080417000247 IN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 2567540453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

1684 Bush LN
Crawfordsville, IN 47933-3364
Phone (765) 365-9500

250 W 96TH St
Suite 520
Indianapolis, IN 46260-1317

3900 St Francis Way
Suite 205
Lafayette, IN 47905-4939
Phone (765) 428-2500

8433 Harcourt Rd
Suite 100
Indianapolis, IN 46260-2193
Phone (317) 583-7600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Medical Group, Inc. Cardiovascular Disease CurrentSince Jun 10, 2010 Accepting new patients
The Care Labs, LLC Past Accepting new patients
Care Group LLC Cardiovascular Disease Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
St Vincent Medical Group Inc Cardiovascular Disease Past Accepting new patients

Locations

1684 Bush Ln
Crawfordsville, IN 47933
Phone (765) 365-9500

8433 Harcourt Rd
Ste 100
Indianapolis, IN 46260
Phone (317) 583-7702

8333 Naab Rd
Ste 400
Indianapolis, IN 46260
Phone (317) 338-5066

250 W 96th St
Ste 520
Indianapolis, IN 46260
Phone (317) 583-3211

3900 St Francis Way
Ste 205
Lafayette, IN 47905
Phone (765) 428-2500

Organizations & group practices 5

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

Hospital & facility affiliations 5

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1154397701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 ST FRANCIS WAY STE 205",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 ST FRANCIS WAY STE 205",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054939",
            "telephone_number": "765-428-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "SAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01054645A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200342990",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sam.hansen.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "3900 St Francis Way Ste 205",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479054939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.