Gautam Phookan, MD

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

01050143A Issued in IN

Practice address

2525 W University Ave Ste 503
Muncie, IN 47303-3409

Phone

(765) 288-0441

Fax

(765) 282-7879

NPI assigned

Jun 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Indiana University Health Ball Memorial Physicians, Inc.

  • Family Medicine Physician
  • Muncie, IN
  • NPI 1235455544
  Medicare reassignment NPD
• University Family Physicians, Inc.

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1043275787
  Medicare reassignment NPD
• University Family Physicians, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Indianapolis, IN
  • NPI 1669828042
  NPD
• Indianapolis Neurosurgical Group

  • Neurological Surgery Physician
  • Muncie, IN
  • NPI 1942376926
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1093750978",
    "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": "2525 W UNIVERSITY AVE STE 503",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473033409",
            "telephone_number": "765-288-0441",
            "fax_number": "765-282-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOOKAN",
        "first_name": "GAUTAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IN",
            "license": "1050143",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IN",
            "license": "01050143A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "061570015",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "M22404245",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200206470A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gphookan@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "2525 W University Ave",
            "address_2": "Suite 503",
            "city": "Muncie",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473033421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Megan Phillips, MA, BCBA
• Olivia Phillips, PA-C
• Rebecca Phipps, NP
• Phoenix Habilitation, LLC
• Jennifer Lynn Phoenix
• Mai T Phung, D.O.
• Physical Medicine & Rehabilitation of East Central Indiana, PC
• Courtney Picillo
• Lynn L Pickett
• Ashlee M Pierce, NP

• Neurological Surgery Physician in Muncie, IN
• Providers in Muncie, IN by specialty
• Neurological Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.