NPIMap

Individual provider Active NPI

John P Cusack, MD

  • Family Medicine Physician
  • Lafayette, IN
National Provider Identifier
1144298233
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01042414A Issued in IN
Practice address
3554 Promenade Pkwy
Suite F
Lafayette, IN 47909-8418
Phone
(765) 477-2200
Fax
(765) 477-0277
NPI assigned
Mar 14, 2006
Last updated
Mar 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01042414A IN Primary

Addresses

Primary practice location

3554 Promenade Pkwy
Suite F
Lafayette, IN 47909-8418

Mailing address

PO Box 4699
Lafayette, IN 47903-4699
Phone (765) 449-2732

Other identifiers 2

IdentifierTypeStateIssuer
000000348750OtherINANTHEM PROVIDER NUMBER
100461530MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address johncusack@idx.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041102000636 IN Practitioner - Family Practice 0042297046 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unity Healthcare LLCGroup PAC ID 0244123362, 62 clinicians

Practice addresses (Care Compare)

1250 S Creasy LN
Suite a
Lafayette, IN 47905-4960
Phone (765) 446-5417

1345 Unity PL
Lafayette, IN 47905-5761

166 Sagamore Pkwy W
Garan Chadha MD
West Lafayette, IN 47906-1569
Phone (765) 449-2458

3554 Promenade Pkwy
Suite F
Lafayette, IN 47909-8418
Phone (765) 471-9146

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01042414AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unity Healthcare LLC CurrentSince Jan 1, 2005 Accepting new patients
Unity Healthcare, LLC CurrentSince Jan 1, 2005 Accepting new patients
Unity Healthcare, LLC Family Medicine Current Accepting new patients
Unity Healthcare, LLC Family Medicine Past Accepting new patients
Unity Healthcare LLC Past Accepting new patients

Locations

1345 Unity Pl
Ste 235
Lafayette, IN 47905
Phone (765) 446-5065

3554 Promenade Pkwy
Ste F
Lafayette, IN 47909
Phone (765) 471-9146

152 Sagamore Pkwy W
West Lafayette, IN 47906
Phone (765) 423-6556

Interoperability endpoints

  • Direct secure messaging: jcusack106969@direct.franciscanalliance.org
  • Direct secure messaging: johncusack@idx.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1144298233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4699",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479034699",
            "telephone_number": "765-449-2732",
            "fax_number": "765-449-1196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3554 PROMENADE PKWY",
            "address_2": "SUITE F",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479098418",
            "telephone_number": "765-477-2200",
            "fax_number": "765-477-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSACK",
        "first_name": "JOHN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01042414A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000348750",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100461530",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "johncusack@idx.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "3554 Promenade Pkwy",
            "address_2": "Suite F",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479098418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.