Individual provider Active NPI

Peter C Jenkins, MD

  • Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1083761019
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01074216A Issued in IN
Practice address
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone
(317) 630-7582
Fax
(317) 630-7694
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301101564 MI
Surgery Physician 208600000X MT185869 PA
Surgical Critical Care Physician 2086S0102X 01074216A IN
Surgery Physician 208600000X 01074216A IN Primary

Addresses

Primary practice location

1701 N Senate Blvd
Indianapolis, IN 46202-1239

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

1801 N Senate Blvd.
Suite 635
Indianapolis, IN 46202-1239
Phone (317) 963-1400

Other practice location 2

2401 W University Ave
Muncie, IN 47303-3428
Phone (765) 289-6381

Other identifiers 1

IdentifierTypeStateIssuer
201233600MedicaidIN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pjenkins1@direct.iuhealth.org Direct
Direct Messaging Address pjenkins1@direct.iuhealth.org Direct

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
I20140715000344 IN Practitioner - General Surgery 4880828730 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Perelman School of Med at the University of Pennsylvania, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Surgeons IncGroup PAC ID 9436171949, 126 clinicians
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (317) 944-5000

550 University Blvd
Indianapolis, IN 46202-5149

Hospital & facility affiliations

  • Indiana University Health Hospital, Indianapolis, IN, CCN 150056

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01074216AINMDSurgery Physician
4301101564MIMDSurgery Physician
MT185869PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC CurrentSince Jan 1, 2026 Accepting new patients
Indiana University Health Ball Memorial Physicians, Inc. Surgery CurrentSince Jun 15, 2022 Accepting new patients
University Surgeons, Inc. Surgery CurrentSince Aug 15, 2014 Accepting new patients

Locations

7630 Solutions Ctr
Chicago, IL 60677

3832 Solutions Ctr
Chicago, IL 60677

1801 Senate Blvd
Ste 635
Indianapolis, IN 46202
Phone (317) 923-7211

1701 N Senate Ave
Indianapolis, IN 46202
Phone (317) 929-8447

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Ste 130
Indianapolis, IN 46219
Phone (317) 962-4836

550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

221 N Celia Ave
Muncie, IN 47303
Phone (765) 747-3141

2401 W University Ave
Muncie, IN 47303
Phone (765) 747-3111

Interoperability endpoints

  • Direct secure messaging: pjenkins1@direct.iuhealth.org

Organizations & group practices 3

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 1

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": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1083761019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N SENATE BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239",
            "telephone_number": "317-630-7582",
            "fax_number": "317-630-7694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 N Senate Blvd.",
            "address_2": "Suite 635",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "317-963-1400",
            "fax_number": "317-962-2595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2401 W University Ave",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473033428",
            "country_code": "US",
            "telephone_number": "765-289-6381",
            "fax_number": "765-448-7646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "PETER",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301101564",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT185869",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IN",
            "license": "01074216A",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01074216A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201233600",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjenkins1@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1801 N Senate Blvd.",
            "address_2": "Suite 635",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjenkins1@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2401 W University Ave",
            "city": "Muncie",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473033428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.