Mary Ellyn Samels, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10004528A Issued in IN

Practice address

5230 E Stop 11 Rd Ste 150
Indianapolis, IN 46237-6399

Phone

(317) 865-5904

Fax

(317) 865-5321

NPI assigned

Sep 30, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Franciscan Health Indianapolis Hospital, Indianapolis, IN, CCN 150162
• Major Hospital Hospital, Shelbyville, IN, CCN 150097
• Rush Memorial Hospital Hospital, Rushville, IN, CCN 151304

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Franciscan Physician Network

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1225327984
  Medicare reassignment Care Compare group NPD (past)
• Franciscan Physician Network

  dba Franciscan Immediate Care

  • Urgent Care Clinic/Center
  • Mishawaka, IN
  • NPI 1366879009
  NPD
• Franciscan Physician Network

  • Clinic/Center
  • Lafayette, IN
  • NPI 1992543250
  NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Franciscan Health Indianapolis & Mooresville

  dba Franciscan Health Indianapolis Orthopedic Hospital

  • General Acute Care Hospital
  • Carmel, IN
  • NPI 1376214981
  Care Compare affiliation
• Franciscan Health Indianapolis & Mooresville

  dba Franciscan Health - Indianapolis

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1386749893
  Care Compare affiliation
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  Care Compare affiliation
• Rush Memorial Hospital

  • Critical Access Hospital
  • Rushville, IN
  • NPI 1497726020
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1598583544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 E STOP 11 RD STE 150",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462376399",
            "telephone_number": "317-865-5904",
            "fax_number": "317-865-5321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5320 East Stop 11 Road",
            "address_2": "Suite 150",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "46237",
            "country_code": "US",
            "telephone_number": "219-718-7756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMELS",
        "first_name": "MARY",
        "middle_name": "ELLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004528A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sam's Club Optical (Sam's Club Optical 30-6304)
• Sam's Club Optical (Sam's Club Optical 30-08168)
• Hala Samaan
• Srinivas Sambaraju
• Pritham Sambathur
• Mahmoud Samman, MD
• Brad Sammons, DDS
• Ibrahim Abdallah Sammour, M.D.
• Yasser Yahya Sammour
• Raisa Samonte

• Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.