Active NPI
Jeffrey A. Eck, M.D.
- Family Medicine Physician
- Goshen, IN
National Provider Identifier
1073512703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01037711A
- Practice address
- 2824 Elkhart Rd
Goshen, IN 46526 - Phone
- (574) 535-1700
- Fax
- (574) 535-1799
- NPI assigned
- Jul 15, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01037711A | IN | Primary |
Addresses
Primary practice location
2824 Elkhart Rd
Goshen, IN 46526
Mailing address
2824 Elkhart Rd
Goshen, IN 46526-1014
Other practice location 1
3421 S Main St
Elkhart, IN 46517-3125
Phone (574) 295-7178
Other practice location 2
3421 S Main St
Elkhart, IN 46517-3125
Phone (574) 295-7178
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01319982 | Other | IN | RR MEDICARE |
| 000000109325 | Other | IN | ANTHEM NUMBER |
| 100475080A | Medicaid | IN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01037711A | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556150400000",
"number": "1073512703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2824 ELKHART RD",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465261014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2824 ELKHART RD",
"city": "GOSHEN",
"state": "IN",
"postal_code": "46526",
"telephone_number": "574-535-1700",
"fax_number": "574-535-1799"
}
],
"practiceLocations": [
{
"address_1": "3421 S Main St",
"address_purpose": "LOCATION",
"city": "Elkhart",
"state": "IN",
"postal_code": "465173125",
"country_code": "US",
"telephone_number": "574-295-7178",
"fax_number": "574-295-8822",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3421 S Main St",
"address_purpose": "LOCATION",
"city": "Elkhart",
"state": "IN",
"postal_code": "465173125",
"country_code": "US",
"telephone_number": "574-295-7178",
"fax_number": "574-295-8822",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ECK",
"first_name": "JEFFREY",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-15",
"last_updated": "2019-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01037711A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P01319982",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM NUMBER",
"identifier": "000000109325",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100475080A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.