Individual provider Active NPI

Shaun Hicks, MD

  • Neonatal-Perinatal Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1073618575
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
01056396 Issued in IN
Practice address
8111 Township Line Rd
Indianapolis, IN 46260-2479
Phone
(317) 415-7921
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 01056396 IN Primary

Addresses

Primary practice location

8111 Township Line Rd
Indianapolis, IN 46260-2479

Mailing address

PO Box 68952
Indianapolis, IN 46268-0952
Phone (317) 802-3124

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
I20191127002422 IN Practitioner - Pediatric Medicine 5395178651 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01056396INMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Pediatric Subspecialties CurrentSince Jan 1, 2020 Accepting new patients
St Vincent Physician Services Hospital and Health Care Center CurrentSince Jan 31, 2026 Accepting new patients
St Vincent Physician Services Hospital and Health Care Center CurrentSince Jan 31, 2026 Accepting new patients
St Vincent Pediatric Subspecialties Neonatal-Perinatal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Major Hospital Past Accepting new patients
Saint Vincent Physician Services, Inc. Past Accepting new patients

Locations

2001 W 86th St
Indianapolis, IN 46260
Phone (317) 338-3617

8081 Township Line Rd
Ste 203
Indianapolis, IN 46260
Phone (317) 415-7921

8414 Naab Rd
Indianapolis, IN 46260
Phone (317) 338-1600

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

8111 Township Line Rd
Indianapolis, IN 46260
Phone (317) 415-7921

Interoperability endpoints

  • Direct secure messaging: shaun.hicks.1@7598.direct.athenahealth.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192752000000",
    "number": "1073618575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 68952",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462680952",
            "telephone_number": "317-802-3124",
            "fax_number": "317-870-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8111 TOWNSHIP LINE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602479",
            "telephone_number": "317-415-7921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "SHAUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01056396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.