NPIMap

Individual provider Active NPI

Faris Fadheel, M.D.

  • Neurology Physician
  • Evansville, IN
National Provider Identifier
1205836608
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
01052686A Issued in IN
Practice address
1312 Professional Blvd Ste 201
Evansville, IN 47714-8019
Phone
(812) 476-7523
Fax
(812) 476-6686
NPI assigned
Jul 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036101230 IL
Neurology Physician 2084N0400X 4301065910 MI
Neurology Physician 2084N0400X 01052686A IN Primary

Addresses

Primary practice location

1312 Professional Blvd Ste 201
Evansville, IN 47714-8019

Mailing address

1312 Professional Blvd Ste 201
Evansville, IN 47714-8019
Phone (812) 476-7523

Other practice location 1

3700 Washington Ave
Evansville, IN 47714-0541
Phone (812) 476-7523

Other practice location 2

801 Saint Marys Dr Ste 400E
Evansville, IN 47714-0524
Phone (812) 476-7523

Other identifiers 1

IdentifierTypeStateIssuer
200271080AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address faris.fadheel.1@7598.direct.athenahealth.com St Mary's Medical Group, LLC

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
I20101201001077 IN Practitioner - Neurology 9234325234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical Group LLCGroup PAC ID 1153493341, 230 clinicians
Easter Seals Rehabilitation Center IncGroup PAC ID 8426135179, shared by 3 NPIs, 41 clinicians

Practice addresses (Care Compare)

3700 Washington Ave
Evansville, IN 47714-0541

3701 Bellemeade Ave
Evansville, IN 47714-0137
Phone (812) 479-1411

801 Saint Marys Dr
Evansville, IN 47714-0524

801 Saint Marys Dr
505E
Evansville, IN 47714-0528
Phone (812) 491-3236

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036101230ILMDNeurology Physician
01052686AINMDNeurology Physician
4301065910MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary's Medical Group, LLC CurrentSince Apr 1, 2024 Accepting new patients
St Mary's Medical Group, LLC CurrentSince Apr 1, 2024 Accepting new patients
St. Mary's Health, Inc Neurology Past Accepting new patients

Locations

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

1312 Professional Blvd
Ste 201
Evansville, IN 47714
Phone (812) 476-7523

3700 Washington Ave
Evansville, IN 47714
Phone (812) 232-0021

801 Saint Marys Dr
Ste 400
Evansville, IN 47714
Phone (812) 477-0900

801 Saint Marys Dr
Ste 400E
Evansville, IN 47714
Phone (812) 476-7523

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

Organizations & group practices 3

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1205836608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 PROFESSIONAL BLVD STE 201",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148019",
            "telephone_number": "812-476-7523",
            "fax_number": "812-476-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 PROFESSIONAL BLVD STE 201",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148019",
            "telephone_number": "812-476-7523",
            "fax_number": "812-476-6686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140541",
            "country_code": "US",
            "telephone_number": "812-476-7523",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Saint Marys Dr Ste 400E",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140524",
            "country_code": "US",
            "telephone_number": "812-476-7523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FADHEEL",
        "first_name": "FARIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036101230",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301065910",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01052686A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200271080A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "faris.fadheel.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St Mary's Medical Group, LLC",
            "address_1": "1312 Professional Blvd Ste 201",
            "city": "Evansville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "477148019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.