Individual provider Active NPI

Wade Gilman, MD

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1053970442
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
01091492A Issued in IN
Practice address
2040 N Shadeland Ave Ste 220
Indianapolis, IN 46219-2890
Phone
(317) 355-1435
NPI assigned
Jun 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125075903 IL
Surgery Physician 208600000X LL82357 SC
Student in an Organized Health Care Education/Training Program 390200000X 01091492A IN Primary

Addresses

Primary practice location

2040 N Shadeland Ave Ste 220
Indianapolis, IN 46219-2890

Mailing address

2040 N Shadeland Ave Ste 220
Indianapolis, IN 46219-2890
Phone (317) 355-1435

Other practice location 1

1650 Ridge Ave
Ste 1304
Evanston, IL 60201
Phone (312) 666-3494

Other practice location 2

1402 E County Line Rd
Indianapolis, IN 46227-0963
Phone (317) 887-7000

Other identifiers 1

IdentifierTypeStateIssuer
300080312MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240222001750 IN Practitioner - HospitalistPractitioner - Family Practice 8426387184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
University of Tennessee, HSC, College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

1402 E County Line Rd
Indianapolis, IN 46227-0963
Phone (317) 887-7113

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125075903ILMDFamily Medicine Physician
LL82357SCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc Family Medicine CurrentSince Mar 1, 2024 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Mar 1, 2024 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

1402 E County Line Rd
Southport, IN 46227
Phone (317) 887-7000

Interoperability endpoints

  • Direct secure messaging: wgilman564921@ecommunitydirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1053970442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 N SHADELAND AVE STE 220",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462192890",
            "telephone_number": "317-355-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 N SHADELAND AVE STE 220",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462192890",
            "telephone_number": "317-355-1435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Ridge Ave",
            "address_2": "Ste 1304",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "60201",
            "country_code": "US",
            "telephone_number": "312-666-3494",
            "fax_number": "847-868-8964",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1402 E County Line Rd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462270963",
            "country_code": "US",
            "telephone_number": "317-887-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILMAN",
        "first_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-10",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125075903",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "LL82357",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "01091492A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300080312",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.