Individual provider Active NPI

Callie J Haertle

  • Physician Assistant
  • Lafayette, IN
National Provider Identifier
1871394429
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1701 S Creasy LN
Lafayette, IN 47905-4972
Phone
(765) 502-4000
NPI assigned
Mar 20, 2025
Last updated
Jun 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1701 S Creasy LN
Lafayette, IN 47905-4972

Mailing address

530 Massachusetts Ave Apt 302
Indianapolis, IN 46204-2331
Phone (262) 468-5421

Other practice location 1

1710 Lafayette Rd
Crawfordsville, IN 47933-1033
Phone (765) 362-2800

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250825001171 IN Practitioner - Physician Assistant 6305346339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 Corporate Blvd
Lafayette, LA 70508-3844

Hospital & facility affiliations

National Provider Directory

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

Organizations & group practices 1

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.

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": "1742428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1871394429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 MASSACHUSETTS AVE APT 302",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462042331",
            "telephone_number": "262-468-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 S CREASY LN",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054972",
            "telephone_number": "765-502-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1710 Lafayette Rd",
            "address_purpose": "LOCATION",
            "city": "Crawfordsville",
            "state": "IN",
            "postal_code": "479331033",
            "country_code": "US",
            "telephone_number": "765-362-2800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAERTLE",
        "first_name": "CALLIE",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-20",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.