Deborah O Patrick, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01031491 Issued in IN

Practice address

550 S Landmark Ave
Bloomington, IN 47403-3239

Phone

(812) 330-3688

Fax

(812) 331-3656

NPI assigned

Dec 29, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Deborah O Ciancone Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1164409249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474021329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-330-3688",
            "fax_number": "812-331-3656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "888 S Auto Mall Rd",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474015430",
            "country_code": "US",
            "telephone_number": "812-353-2700",
            "fax_number": "812-353-2701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "DEBORAH",
        "middle_name": "O",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01031491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100055990",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBORAH",
            "last_name": "CIANCONE",
            "middle_name": "O",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Divya D Patel, R.PH
• Rita R Patel, SLP
• Pathways Counseling Center
• Bradley Patitz
• Patricia Muyskens Counseling and Consultation
• Donald Curtis Patrick, RBT
• Kourtney Patrick, MS, RD, LD
• Jade Patterson, RBT
• Mistydawn Patterson, PMH-BC, RN
• Nicholas Pattinson, RBT

• Family Medicine Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.