Individual provider Active NPI

Donald D Vaughn, FNP-C

  • Family Nurse Practitioner
  • Newburgh, IN
National Provider Identifier
1194796987
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71007878A Issued in IN
Practice address
4222 Bell Rd Ste 5
Newburgh, IN 47630-2541
Phone
(812) 758-3032
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 15880 TN
Family Nurse Practitioner 363LF0000X 71007878A IN Primary

Addresses

Primary practice location

4222 Bell Rd Ste 5
Newburgh, IN 47630-2541

Mailing address

PO Box 28227
Belfast, ME 04915-2034

Other identifiers 2

IdentifierTypeStateIssuer
3970044MedicaidTN
300014171MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160229002650 FL Practitioner - Nurse Practitioner 6406946060 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71007878AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neurology Associates of Ormond Beach PA CurrentSince Jan 1, 2016 Accepting new patients
Everside Health, LLC Past Accepting new patients

Locations

8 Mirror Lake Dr
Ste A
Ormond Beach, FL 32174
Phone (386) 673-2500

Interoperability endpoints

  • Direct secure messaging: don.vaughn.1@14940.direct.athenahealth.com

Organizations & group practices 2

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1194796987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28227",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4222 BELL RD STE 5",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302541",
            "telephone_number": "812-758-3032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "DONALD",
        "middle_name": "D",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "15880",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007878A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3970044",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300014171",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

Verify at the official NPI Registry.