Mallory Hanewich, FNP-C
Individual provider Active NPI Nurse Practitioner · Wheatfield, IN
NPI 1497576052 · NPPES record last updated Oct 17, 2024
Key facts
- NPI
- 1497576052
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71015853A (IN)
- Practice address
- 3988 W State Road 10
Wheatfield, IN 46392-9251 - Phone
- (219) 987-3581
- NPI assigned
- Oct 17, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Porter Physician Services LLC
Practice addresses (Care Compare)
3988 W State Rd
Suite 10
Wheatfield, IN 46392-9251
Phone (219) 270-3400
650 Dickinson Rd
Chesterton, IN 46304-3387
Hospital & facility affiliations
- Elara Caring
- Franciscan Home Care
- Franciscan Health Crown Point
- Northwest Health - Porter
- Franciscan Health Rensselaer, Inc
- St Mary Medical Center Inc
- Methodist Hospitals Inc
- Powers Health Rehabilitation Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241219003881 | IN | Practitioner - Nurse Practitioner | 7416484084 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Porter Physician Services LLC | Nurse Practitioner | Current |
Accepting new patients |
| Porter Physician Services LLC | Past | Accepting new patients |
Locations
650 Dickinson Rd
Ste Z
Chesterton, IN 46304
Phone (219) 464-9507
650 Dickinson Rd
Ste A
Chesterton, IN 46304
Phone (219) 926-2133
3988 W State Road 10
Wheatfield, IN 46392
Phone (219) 270-3400
Interoperability endpoints
- mallory.hanewich.1@2340.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71015853A | IN | Yes |
Addresses
Primary practice location
3988 W State Road 10
Wheatfield, IN 46392-9251
Mailing address
7402 N 400 W
Rensselaer, IN 47978-7528
Phone (219) 869-3675
Other providers in Wheatfield, IN
- Jessica Jean Deboer
- Corinne Michelle Djuric
- Franciscan Health Rensselaer, Inc.
- Franciscan Health Rensselaer, Inc.
- Franklin-McCallister
- Erin A Husch
- Jasper County Hospital
- Kankakee Valley School Corporation
- Kankakee Vallley School Corporation
- Kathleen Kleefisch
All providers in Wheatfield, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.