Nader Rezvan, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

01023405 Issued in IN

Practice address

601 W 2ND St
Bloomington, IN 47403-2317

Phone

(866) 483-4804

Fax

(317) 870-0499

NPI assigned

Dec 18, 2006

Last updated

May 13, 2016By the provider in NPPES

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463097600000",
    "number": "1194888644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 N DUNN ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474081327",
            "telephone_number": "866-483-4804",
            "fax_number": "317-870-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W 2ND ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032317",
            "telephone_number": "866-483-4804",
            "fax_number": "317-870-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVAN",
        "first_name": "NADER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2016-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "01023405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100182840A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.