NPIMap

Individual provider Active NPI

Andrea Leigh Haller, MD

  • Neurology Physician
  • Fort Wayne, IN
National Provider Identifier
1407853146
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
01053486A Issued in IN
Practice address
7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone
(260) 436-2416
Fax
(260) 436-9662
NPI assigned
Jul 7, 2005
Last updated
Sep 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 01053486A IN Primary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 01053486A IN

Addresses

Primary practice location

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

306 E Maumee St Ste 103
Angola, IN 46703-2038
Phone (260) 436-2416

Other identifiers 1

IdentifierTypeStateIssuer
200295410MedicaidIN

Other names 1

  • Andrea L Marcus Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ahaller@direct.iuhealth.org Direct

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
I20060206000722 IN Practitioner - Neurology 6406860071 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of California, San Francisco School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
50.34 of 100Reported as group
Quality
41.58
Promoting interoperability
0
Improvement activities
40
Cost
73.15

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01053486AINMDSleep Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Fort Wayne Physicians, LLC CurrentSince Sep 10, 2023 Accepting new patients
Iu Health Medical Group, LLC CurrentSince Oct 1, 2025 Accepting new patients
Indiana Neuroscience Assoc Inc Neurology Past Accepting new patients
Major Hospital Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

306 E Maumee St
Angola, IN 46703
Phone (260) 667-5335

306 E Maumee St
Ste 103
Angola, IN 46703
Phone (260) 432-1800

256 E Pettit Ave
Ste 100
Fort Wayne, IN 46806

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

7956 W Jefferson Blvd
Fort Wayne, IN 46804

1500 N Ritter Ave
Indianapolis, IN 46219
Phone (317) 355-5041

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

140 Fox Rd
Ste 209
Van Wert, OH 45891
Phone (419) 222-6595

Interoperability endpoints

  • Direct secure messaging: ahaller@direct.iuhealth.org

Organizations & group practices 6

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 8

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1407853146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7956 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-2416",
            "fax_number": "260-436-9662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "306 E Maumee St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Angola",
            "state": "IN",
            "postal_code": "467032038",
            "country_code": "US",
            "telephone_number": "260-436-2416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALLER",
        "first_name": "ANDREA",
        "middle_name": "LEIGH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01053486A",
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "IN",
            "license": "01053486A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200295410",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahaller@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7956 W Jefferson Blvd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "MARCUS",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.