Alice Camille Otto, NP

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

71003805A Issued in IN

Practice address

2605 N Lebanon St
Lebanon, IN 46052-1476

Phone

(765) 485-8000

NPI assigned

Jan 3, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Miss Alice Camille Ketchem Former name

Electronic endpoints 1

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

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ies HSP Indiana LLCGroup PAC ID 4486189040, 25 clinicians

Hancock Physician Network LLCGroup PAC ID 8325952633, 139 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hancock Regional Hospital Hospital, Greenfield, IN, CCN 150037
• Johnson Memorial Hospital Hospital, Franklin, IN, CCN 150001

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Hancock Physician Network, LLC

  • Family Medicine Physician
  • Greenfield, IN
  • NPI 1609806470

  Registered Nurse

  Medicare reassignment Care Compare group NPD
• Ies HSP Indiana LLC

  • Hospitalist Physician
  • Franklin, IN
  • NPI 1134954647
  Medicare reassignment Care Compare group NPD
• Witham Memorial Hospital

  dba Witham Health Services

  • Family Medicine Physician
  • Lebanon, IN
  • NPI 1083750293
  Medicare reassignment NPD
• Witham Memorial Hospital

  dba Witham Rehabilitation Services, Anson at Whitestown

  • Physical Therapist
  • Zionsville, IN
  • NPI 1952282204
  NPD

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

• Hancock Regional Hospital

  • General Acute Care Hospital
  • Greenfield, IN
  • NPI 1467485003
  Care Compare affiliation
• Johnson Memorial Hospital

  • General Acute Care Hospital
  • Franklin, IN
  • NPI 1346248986
  Care Compare affiliation
• Johnson Memorial Hospital

  dba JMH Immediate/Occupation Health

  • Occupational Medicine Clinic/Center
  • Franklin, IN
  • NPI 1679577357

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1841594025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476",
            "telephone_number": "765-485-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "ALICE",
        "middle_name": "CAMILLE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-03",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28196305A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71003805A",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "71003805A",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "71003805A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201042160",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aotto@withamdirect.org",
            "affiliation": "Y",
            "affiliationName": "Witham Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2605 N Lebanon St",
            "city": "Lebanon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460521476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALICE",
            "last_name": "KETCHEM",
            "middle_name": "CAMILLE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nizar Olabi, DO
• Donna Kay Oland, RN, BHS, MBA
• John F Olson, MD
• Hannah Oshaughnessy, LMHC
• Ossip Optometry, P.C.
• Autumn Overbay, LCSW
• Marissa Overbey, RBT
• Nicole Marie Owens
• Ben H Park, MD
• Annabel G Parks, DT

• Hospitalist Physician in Lebanon, IN
• Providers in Lebanon, IN by specialty
• Hospitalist Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.