Individual provider Active NPI

Nicholas J Hammond, P.A.

  • Medical Physician Assistant
  • Fort Wayne, IN
National Provider Identifier
1265618722
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10000887A Issued in IN
Practice address
604 W Berry St
Fort Wayne, IN 46802-2106
Phone
(260) 423-1331
NPI assigned
Jan 15, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 10000887A IN Primary

Addresses

Primary practice location

604 W Berry St
Fort Wayne, IN 46802-2106

Mailing address

604 W Berry St
Fort Wayne, IN 46802-2106
Phone (260) 423-1331

Other identifiers 1

IdentifierTypeStateIssuer
10000887AOtherININ LICENSE

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
I20120207000549 IN Practitioner - Physician Assistant 2264699099 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rpinmd LLCGroup PAC ID 4183014616, 13 clinicians

Practice addresses (Care Compare)

6326 Constitution Dr
Fort Wayne, IN 46804-1518
Phone (260) 515-3275

Hospital & facility affiliations

  • Purposecare of Indiana Home health agency, Indianapolis, IN, CCN 157252
  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10000887AINMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allen County Cardiology LLC PastSince Dec 2, 2024 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72187

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 and National Provider Directory roles.

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": "1200355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200355200000",
    "number": "1265618722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 W BERRY ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022106",
            "telephone_number": "260-423-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 W BERRY ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022106",
            "telephone_number": "260-423-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMMOND",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-15",
        "last_updated": "2008-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10000887A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN LICENSE",
            "identifier": "10000887A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.