Active NPI
Aeden J Ligon
- Sports Medicine (Emergency Medicine) Physician
- Fort Wayne, IN
National Provider Identifier
1003666470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Emergency Medicine) Physician
- License
- 36003793A
- Practice address
- 9216 Crystal Spring Dr
Fort Wayne, IN 46804-6510 - Phone
- (765) 480-9828
- NPI assigned
- Mar 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 36003793A | IN | Primary |
Addresses
Primary practice location
9216 Crystal Spring Dr
Fort Wayne, IN 46804-6510
Mailing address
9216 Crystal Spring Dr
Fort Wayne, IN 46804-6510
Phone (765) 480-9828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36003793A | IN | MD | Sports Medicine (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711411200000",
"number": "1003666470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9216 CRYSTAL SPRING DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046510",
"telephone_number": "765-480-9828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9216 CRYSTAL SPRING DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046510",
"telephone_number": "765-480-9828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGON",
"first_name": "AEDEN",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-26",
"last_updated": "2024-03-26",
"certification_date": "2023-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "207PS0010X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Sports Medicine",
"state": "IN",
"license": "36003793A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.