NPIMap

Individual provider Active NPI

Thayer Nasereddin, MD

  • Gastroenterology Physician
  • Fort Wayne, IN
National Provider Identifier
1215391701
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01087422A Issued in IN
Practice address
11050 Parkview Circle Dr
Fort Wayne, IN 46845-1739
Phone
(833) 724-8326
Fax
(260) 266-7935
NPI assigned
Apr 11, 2016
Last updated
May 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01087422A IN Primary

Addresses

Primary practice location

11050 Parkview Circle Dr
Fort Wayne, IN 46845-1739

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other practice location 1

8051 S Emerson Ave Ste 200
Indianapolis, IN 46237-8632
Phone (317) 865-2955

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
I20221209002523 IN Practitioner - Gastroenterology 6901275106 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indianapolis Gastroenterology LLCGroup PAC ID 0244201432, 18 clinicians

Practice addresses (Care Compare)

8051 S Emerson Ave
Suite 200
Indianapolis, IN 46237-8632
Phone 31786529554419

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.29 of 100Reported as group
Quality
64.57
Promoting interoperability
99
Improvement activities
40
Cost
83.9

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy71
Upper gastrointestinal (GI) endoscopy for acid reflux332

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01087422AINMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System,Inc. Gastroenterology CurrentSince Sep 8, 2022 Accepting new patients
Indianapolis Gastroenterology, LLC Gastroenterology CurrentSince Jul 1, 2023 Accepting new patients
Parkview Health System Inc Current Accepting new patients
Major Hospital Past Accepting new patients

Locations

11050 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (833) 724-8326

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

8051 S Emerson Ave
Ste 200
Indianapolis, IN 46237

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1d5dc169-f536-4ee1-9c67-c93c23521729/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1215391701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 PARKVIEW CIRCLE DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451739",
            "telephone_number": "833-724-8326",
            "fax_number": "260-266-7935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8051 S Emerson Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462378632",
            "country_code": "US",
            "telephone_number": "317-865-2955",
            "fax_number": "317-865-2954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NASEREDDIN",
        "first_name": "THAYER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01087422A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.