Individual provider Active NPI

Michael A Agostino, MD

  • Otolaryngology Physician
  • Noblesville, IN
National Provider Identifier
1164458352
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
01038563 Issued in IN
Practice address
18051 River Road
Suite 104
Noblesville, IN 46062-7093
Phone
(317) 844-7059
Fax
(317) 819-0044
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 01038563 IN Primary

Addresses

Primary practice location

18051 River Road
Suite 104
Noblesville, IN 46062-7093

Mailing address

10201 N Illinois St Ste 110
Carmel, IN 46290-1172
Phone (317) 844-7059

Other identifiers 3

IdentifierTypeStateIssuer
100361740AMedicaidIN
000000085510OtherINANTHEM PIN
01038563OtherINLICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MAGOSTINO@OA2046.SRS-DIRECT.COM Direct Otolaryngology Associates, LLC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080925000735 IN Practitioner - Otolaryngology 1850468281 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01038563INMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Apr 24, 2022 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Apr 24, 2022 Accepting new patients
Otolaryngology Associates, LLC Otolaryngology CurrentSince Jun 1, 2013 Accepting new patients
Otorhinolaryngology, Inc Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

3113 Broadway St
Anderson, IN 46012
Phone (765) 298-4660

10201 N Illinois St
Ste 110
Carmel, IN 46290
Phone (317) 819-2825

13100 E 136th St
Ste 1200
Fishers, IN 46037
Phone (317) 573-4370

9002 N Meridian St
Ste 222
Indianapolis, IN 46260
Phone (317) 573-4370

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

18051 River Rd
Ste 104
Noblesville, IN 46062
Phone (317) 573-4370

Interoperability endpoints

  • Direct secure messaging: magostino@oa2046.srs-direct.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/IEEADA

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1164458352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 N ILLINOIS ST STE 110",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "462901172",
            "telephone_number": "317-844-7059",
            "fax_number": "317-819-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18051 RIVER ROAD",
            "address_2": "SUITE 104",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460627093",
            "telephone_number": "317-844-7059",
            "fax_number": "317-819-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGOSTINO",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2024-06-21",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01038563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100361740A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000085510",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "01038563",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MAGOSTINO@OA2046.SRS-DIRECT.COM",
            "affiliation": "Y",
            "affiliationName": "Otolaryngology Associates, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9002 North Meridian Street",
            "address_2": "Suite 222",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462605350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Noblesville, IN

Sources for this page

Verify at the official NPI Registry.