Individual provider Active NPI

Cassandra Christine Porter, PA-C

  • Physician Assistant
  • Kokomo, IN
National Provider Identifier
1720365331
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10001355A Issued in IN
Practice address
3512 S Lafountain St
Kokomo, IN 46902-3803
Phone
(657) 763-1007
NPI assigned
Nov 10, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 363A00000X NC
Physician Assistant 363A00000X 10001355A IN Primary

Addresses

Primary practice location

3512 S Lafountain St
Kokomo, IN 46902-3803

Mailing address

2254 Seasons South Dr Unit 1115
Carmel, IN 46280-1664

Other practice location 1

1801 N Senate Blvd
Indianapolis, IN 46202-1228
Phone (317) 962-6467

Other practice location 2

449 N Wendover Rd Ste A
Charlotte, NC 28211-1064
Phone (704) 316-6005

Other practice location 3

1801 N Senate Blvd
Indianapolis, IN 46202-1228
Phone (317) 963-1950

Other identifiers 3

IdentifierTypeStateIssuer
300097298MedicaidIN
PA.0004348OtherCOP A LICENSE
14730081MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cporter@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20111213000695 IN Practitioner - Physician Assistant 4880869247 Reassigns benefits to 3 organizations
I20160602002380 CO Practitioner - Physician Assistant 4880869247

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
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

Hospital & facility affiliations

  • Indiana University Health Hospital, Indianapolis, IN, CCN 150056

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4348COMDPhysical Medicine & Rehabilitation Physician
10001355AINMDPhysician Assistant
363A00000XNCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Froc, PC CurrentSince May 6, 2016 Accepting new patients
Indiana University Health Care Associates, Inc. CurrentSince May 1, 2025 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Innovative Hospital Care Inc Past Accepting new patients
Emergency Medicine of Indiana LLC Past Accepting new patients
Emergency Medicine of Indiana Past Accepting new patients

Locations

1610 Dry Creek Dr
Ste 200
Longmont, CO 80503
Phone (303) 722-1600

5208 Reliable Pkwy
Chicago, IL 60686

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

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

Interoperability endpoints

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

Organizations & group practices 9

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 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": "1320883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1720365331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2254 SEASONS SOUTH DR UNIT 1115",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "462801664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 S LAFOUNTAIN ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023803",
            "telephone_number": "657-763-1007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021228",
            "country_code": "US",
            "telephone_number": "317-962-6467",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "449 N Wendover Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282111064",
            "country_code": "US",
            "telephone_number": "704-316-6005",
            "fax_number": "704-316-6006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1801 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021228",
            "country_code": "US",
            "telephone_number": "317-963-1950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "CASSANDRA",
        "middle_name": "CHRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-10",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "363A00000X",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001355A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300097298",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "P A LICENSE",
            "identifier": "PA.0004348",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14730081",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cporter@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1801 N Senate Blvd",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.