NPIMap

Individual provider Active NPI

Matthew Nettleman

  • Family Medicine Physician
  • Lafayette, IN
National Provider Identifier
1659756484
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02005338A Issued in IN
Practice address
3743 Landmark Dr Ste 200
Lafayette, IN 47905-6656
Phone
(765) 448-4511
NPI assigned
Jul 22, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02005338A IN Primary

Addresses

Primary practice location

3743 Landmark Dr Ste 200
Lafayette, IN 47905-6656

Mailing address

3743 Landmark Dr Ste 200
Lafayette, IN 47905-6656
Phone (765) 448-4511

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address matthew.nettlemando.p8@direct.ahni.nextgenshare.com 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
I20180710001919 IN Practitioner - Family Practice 6800193095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10995 Allisonville Rd
Suite 100
Fishers, IN 46038-2616
Phone (317) 842-7928

3743 Landmark Dr
Suite 200
Lafayette, IN 47905-6656
Phone (765) 448-4511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions21
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02005338AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Health Network of Indiana LLC CurrentSince Aug 1, 2018 Accepting new patients
American Health Network of Indiana, LLC Family Medicine CurrentSince Aug 1, 2018 Accepting new patients
American Health Network of Indiana, LLC Family Medicine Past Accepting new patients

Locations

8607 E US Highway 36
Ste 300
Avon, IN 46123
Phone (317) 718-6600

8607 E US Highway 36
Ste 100
Avon, IN 46123
Phone (317) 208-3855

10995 Allisonville Rd
Ste 100
Fishers, IN 46038
Phone (317) 842-7928

7440 Woodland Dr
Indianapolis, IN 46278
Phone (317) 450-3357

3743 Landmark Dr
Ste 200
Lafayette, IN 47905
Phone (765) 448-4511

3750 Landmark Dr
Ste A
Lafayette, IN 47905
Phone (765) 448-4511

Interoperability endpoints

  • Direct secure messaging: mnettleman211008@direct.optum.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1659756484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3743 LANDMARK DR STE 200",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479056656",
            "telephone_number": "765-448-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3743 LANDMARK DR STE 200",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479056656",
            "telephone_number": "765-448-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLEMAN",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-22",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02005338A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matthew.nettlemando.p8@direct.ahni.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3750 Landmark Dr Ste A",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479056652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.