Active NPI
Brian D. King, MD
- Family Medicine Physician
- Goshen, IN
National Provider Identifier
1104896307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01035279A
- Practice address
- 2014 S Main St
Suite B
Goshen, IN 46526-5220 - Phone
- (574) 533-8639
- Fax
- (574) 534-9542
- NPI assigned
- Jan 23, 2006
- 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 | 01035279A | IN | Primary |
Addresses
Primary practice location
2014 S Main St
Suite B
Goshen, IN 46526-5220
Mailing address
2014 S Main St
Suite B
Goshen, IN 46526-5220
Phone (574) 533-8639
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100113620 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | brian.kingmd.p1@direct.goshenphysicians.nextgenshare.com | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 01035279A | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610496000000",
"number": "1104896307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2014 S MAIN ST",
"address_2": "SUITE B",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465265220",
"telephone_number": "574-533-8639",
"fax_number": "574-534-9542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2014 S MAIN ST",
"address_2": "SUITE B",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465265220",
"telephone_number": "574-533-8639",
"fax_number": "574-534-9542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "BRIAN",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2021-01-13",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01035279A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100113620",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "brian.kingmd.p1@direct.goshenphysicians.nextgenshare.com",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "2014 S Main St",
"address_2": "Suite B",
"city": "Goshen",
"state": "IN",
"country_code": "US",
"postal_code": "465265220",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.