Etta H Eckerstrom, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71012784A Issued in IN

Practice address

1701 N Senate Blvd
Indianapolis, IN 46202-1239

Phone

(317) 217-2166

NPI assigned

May 19, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Arts, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eeckerstro@direct.iuhealth.org
• Direct secure messaging: eeckerstrom@direct.iuhealth.org

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.

• Indiana University Health Care Associates, Inc

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1902032832
  Medicare reassignment NPD
• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777
  Medicare reassignment NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537
  NPD (past)

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

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1922745009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N SENATE BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239",
            "telephone_number": "317-217-2166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 W Campus Dr",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CT",
            "postal_code": "064773646",
            "country_code": "US",
            "telephone_number": "203-785-2389",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "355 W 16th St Ste 2800",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022279",
            "country_code": "US",
            "telephone_number": "317-963-7300",
            "fax_number": "317-963-7075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ECKERSTROM",
        "first_name": "ETTA",
        "middle_name": "H",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-19",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IN",
            "license": "28274003A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71012784A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eeckerstrom@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "355 W 16th St Ste 2800",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462022279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shawntel C Echoles
• Richard Trevon Echols
• Kellye Echternach, MA, LMHC
• Luke Vincent Eckerle
• Mary K Eckerle, M.D.
• Kimberly A Eckert, N.P
• Luke Eckert
• Nicole Eckert
• Amanda B Eckhardt, PA-C
• Eric Charles Eckman, DDS

• Psychiatric/Mental Health Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.