Individual provider Active NPI

Holly Lyne Terrell

  • Nurse Practitioner
  • Bloomington, IN
National Provider Identifier
1457910689
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71009575A Issued in IN
Practice address
601 W 2ND St
Bloomington, IN 47403-2317
Phone
(812) 353-9515
NPI assigned
Jun 11, 2019
Last updated
Apr 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

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 71009575A IN Primary
Registered Nurse 163W00000X 28167280A IN

Addresses

Primary practice location

601 W 2ND St
Bloomington, IN 47403-2317

Mailing address

PO Box 1329
Bloomington, IN 47402-1329

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
I20191212001610 IN Practitioner - Nurse Practitioner 2961835533 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Practice addresses (Care Compare)

1312 E Hackberry St
Salem, IN 47167-9604
Phone (931) 253-1110

4152 W State Rd
Suite 56
Hanover, IN 47243-9070
Phone (901) 351-1791

560 W Longest St
Paoli, IN 47454-9670
Phone (812) 723-7440

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28167280AINMDRegistered Nurse
71009575AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince May 1, 2024 Accepting new patients
Iu Health Medical Group, LLC Nurse Practitioner CurrentSince Jan 1, 2026 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients
Indiana University Health Paoli Inc CurrentSince Sep 30, 2020 Accepting new patients
Upperline Healthcare, PC Nurse Practitioner CurrentSince Nov 1, 2025 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince May 1, 2024 Accepting new patients
Indiana University Health Paoli Inc CurrentSince Sep 30, 2020 Accepting new patients

Locations

7992 Solution Ctr
Chicago, IL 60677

2900 16th St
Bedford, IN 47421
Phone (812) 275-1200

1159 W Jefferson St
Ste 204
Franklin, IN 46131

4152 W State Road 56
Hanover, IN 47243
Phone (812) 762-4510

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

560 W Longest St
Paoli, IN 47454
Phone (812) 723-7437

642 W Hospital Rd
Paoli, IN 47454
Phone (812) 723-2811

Interoperability endpoints

  • Direct secure messaging: hterrell1@direct.iuhealth.org

Organizations & group practices 8

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": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1457910689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474021329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W 2ND ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032317",
            "telephone_number": "812-353-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRELL",
        "first_name": "HOLLY",
        "middle_name": "LYNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71009575A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28167280A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.