Individual provider Active NPI

Gary Robert Hazlett, M.D.

  • Hospitalist Physician
  • Muncie, IN
National Provider Identifier
1932292737
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
01031249A Issued in IN
Practice address
2401 W University Ave
Muncie, IN 47303-3428
Phone
(765) 747-3111
NPI assigned
Oct 2, 2006
Last updated
Feb 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01031249A IN
Hospitalist Physician 208M00000X 01031249A IN Primary

Addresses

Primary practice location

2401 W University Ave
Muncie, IN 47303-3428

Mailing address

250 N Shadeland Ave
Atth: Provider Enrollment
Indianapolis, IN 46219-4959

Other identifiers 4

IdentifierTypeStateIssuer
100106260AMedicaidIN
200986050MedicaidIN
110085001OtherINMEDICARE RAILROAD
P00980457OtherINRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ghazlett@direct.iuhealth.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070619000532 IN Practitioner - Internal MedicinePractitioner - Hospitalist 9739288507 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01031249AINMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Ball Memorial Physicians, Inc. Internal Medicine CurrentSince Feb 1, 2018 Accepting new patients
Electrocardiographic Interpretation Service, Inc. Past Accepting new patients
Glaucoma Center Inc Past Accepting new patients

Locations

3832 Solutions Ctr
Chicago, IL 60677

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

1200 W White River Blvd
Muncie, IN 47303
Phone (765) 254-4009

221 N Celia Ave
Muncie, IN 47303
Phone (765) 747-3141

2401 W University Ave
Muncie, IN 47303
Phone (765) 747-3111

2525 W University Ave
Muncie, IN 47303
Phone (317) 289-6166

2525 W University Ave
Ste 505
Muncie, IN 47303
Phone (317) 289-6166

Interoperability endpoints

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1932292737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "ATTH: PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W UNIVERSITY AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473033428",
            "telephone_number": "765-747-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZLETT",
        "first_name": "GARY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01031249A",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01031249A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100106260A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200986050",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "110085001",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00980457",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ghazlett@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "2401 W University Ave",
            "city": "Muncie",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473033428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

Verify at the official NPI Registry.