Indy Marie Fairbanks

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4661 Issued in KS

Practice address

402 N River St Ste 200
Derby, KS 67037-1539

Phone

(316) 409-0565

NPI assigned

Sep 10, 2012

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tag Treatment Center LLCGroup PAC ID 0547626178, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Tag Treatment Center LLC

  • Marriage & Family Therapist
  • Wichita, KS
  • NPI 1275011462

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD
• Four County Mental Health Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Independence, KS
  • NPI 1841290251
  Medicare reassignment NPD
• Four County Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Independence, KS
  • NPI 1598845984
  NPD

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1013267756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E 9TH AVE",
            "city": "BELLE PLAINE",
            "state": "KS",
            "postal_code": "670138823",
            "telephone_number": "316-633-3262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 N RIVER ST STE 200",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670371539",
            "telephone_number": "316-409-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "INDY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-10",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "647",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "4661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200964810A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas James Evans
• Ewert Chiropractic LLC
• Expressive Behavior Therapy
• Eye to Eye PA
• Eye to Eye PA
• Lori E Falcone, APRN
• Family Health Center
• Family Medcenters, P.a.
• Family Medcenters, P.a.
• Family Medcenters, P.a.

• Clinical Social Worker in Derby, KS
• Providers in Derby, KS by specialty
• Clinical Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.