Individual provider Active NPI

Anne M Tetrick, PA-C

  • Medical Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1447758438
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10002404A Issued in IN
Practice address
350 W 11TH St
Indianapolis, IN 46202-4108
Phone
(317) 491-6888
Fax
(317) 491-6882
NPI assigned
Jan 25, 2018
Last updated
Feb 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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 10002404A IN Primary

Addresses

Primary practice location

350 W 11TH St
Indianapolis, IN 46202-4108

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address atetrick@direct.iuhealth.org

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
I20180319000062 IN Practitioner - Physician Assistant 2163784802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
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

550 N University Blvd
Indianapolis, IN 46202-5149

705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Phone (317) 944-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10002404AINMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Family Physicians, Inc. CurrentSince Mar 1, 2018 Accepting new patients

Locations

7216 Solutions Ctr
Chicago, IL 60677

1520 N Senate Ave
Indianapolis, IN 46202
Phone (317) 962-0857

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

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

350 W 11th St
Indianapolis, IN 46202
Phone (317) 274-2476

550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000

Interoperability endpoints

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

Organizations & group practices 2

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 1

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": "1516838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1447758438",
    "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": "350 W 11TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462024108",
            "telephone_number": "317-491-6888",
            "fax_number": "317-491-6882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETRICK",
        "first_name": "ANNE",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-25",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10002404A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "atetrick@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "350 W 11th St",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462024108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.