Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Hannah Rae Rudolph

Individual provider Physician Assistant · NPI 1003540204

Hannah Rae Rudolph is a Physician Assistant in Greenwood, Indiana. Qualified in 2024, 2 years ago. Practices with Optima Dermatology LLC, a 74-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
2
Licensed in
IN
In the registry since
2022
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Practice location Address checks out

2800 S State Road 135 Ste 250
Greenwood, IN 46143-6223
Phone: (317) 300-1788
Fax: (317) 743-8103
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10004442A (IN)

Record details

NPI number1003540204
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 13, 2022
Last updated in NPPESAugust 6, 2024
Certification dateAugust 6, 2024
Mailing address111 New Hampshire Ave Ste 2, Portsmouth, NH 03801-2864

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Optima Dermatology Llc — 74 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Greenwood