Active NPI
John R. Danielson, M.D.
- Plastic Surgery Physician
- Merrillville, IN
National Provider Identifier
1104966720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 01034603
- Practice address
- 8053 Cleveland PL
Merrillville, IN 46410-5303 - Phone
- (219) 769-4456
- Fax
- (219) 769-1468
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 01034603 | IN | Primary |
| Surgery of the Hand (Plastic Surgery) Physician | 2082S0105X | 01034603A | IN |
Addresses
Primary practice location
8053 Cleveland PL
Merrillville, IN 46410-5303
Mailing address
8053 Cleveland PL
Merrillville, IN 46410-5303
Phone (219) 769-4456
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100201750A | Medicaid | IN | |
| 240000555 | Other | IN | RAILROAD MEDICARE |
| 000000095467 | Other | ANTHEM |
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 |
|---|---|---|---|
| 01034603 | IN | MD | Plastic Surgery Physician |
| 01034603A | IN | MD | Surgery of the Hand (Plastic Surgery) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Retson Plastic Surgerypc | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215043200000",
"number": "1104966720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8053 CLEVELAND PL",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464105303",
"telephone_number": "219-769-4456",
"fax_number": "219-769-1468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8053 CLEVELAND PL",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464105303",
"telephone_number": "219-769-4456",
"fax_number": "219-769-1468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIELSON",
"first_name": "JOHN",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2008-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "IN",
"license": "01034603",
"primary": true
},
{
"code": "2082S0105X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Plastic Surgery, Surgery of the Hand",
"state": "IN",
"license": "01034603A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100201750A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "240000555",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000095467",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.