MEDICARE: DUSTIN BRADSHAW HAMMERS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	502	WY
2	103G00000X	Clinical Neuropsychologist
3	103G00000X	Clinical Neuropsychologist	6301014253	MI
4	103G00000X	Clinical Neuropsychologist	799688-2501	UT
5	103G00000X	Clinical Neuropsychologist	20043478A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001540973	OTHER	IN	ANTHEM PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356593297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN BRADSHAW HAMMERS PHD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 W 16TH ST STE 2500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2280
Country	:	US
Telephone Number	:	317-963-7204
Fax Number	:	317-963-7211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	03/08/2025

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