Active NPI
Kennard B Sproul, M.D.
- Adult Medicine Physician
- Indianapolis, IN
National Provider Identifier
1043590102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- 01029027A
- Practice address
- 1481 W 10TH St
VA Medical Center
Indianapolis, IN 46202-2803 - Phone
- (317) 554-0000
- NPI assigned
- Aug 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 01029027A | IN | Primary |
Addresses
Primary practice location
1481 W 10TH St
VA Medical Center
Indianapolis, IN 46202-2803
Mailing address
7805 N Crestwood LN
Brazil, IN 47834-8279
Phone (812) 841-9184
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01029027A | IN | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313971200000",
"number": "1043590102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7805 N CRESTWOOD LN",
"city": "BRAZIL",
"state": "IN",
"postal_code": "478348279",
"telephone_number": "812-841-9184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1481 W 10TH ST",
"address_2": "VA MEDICAL CENTER",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022803",
"telephone_number": "317-554-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPROUL",
"first_name": "KENNARD",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-22",
"last_updated": "2011-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "IN",
"license": "01029027A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.