NPIMap

Individual provider Active NPI

John William Fanta

  • Neurology Physician
  • Indianapolis, IN
National Provider Identifier
1215517438
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301513777 Issued in MI
Practice address
1120 W Michigan St # Cl642
Indianapolis, IN 46202-5209
Phone
(317) 278-2686
NPI assigned
Apr 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301513777 MI Primary

Addresses

Primary practice location

1120 W Michigan St # Cl642
Indianapolis, IN 46202-5209

Mailing address

1120 W Michigan St # Cl642
Indianapolis, IN 46202-5209
Phone (317) 278-2686

Other practice location 1

1345 E Parkdale Ave
Manistee, MI 49660-9318
Phone (231) 398-1750

Other practice location 2

3922 Cedar Run Rd
Traverse City, MI 49684-9687
Phone (231) 392-0430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20250819000930 MI Practitioner - Neurology 5890196331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

3922 Cedar Run Rd
Bay Area
Traverse City, MI 49684-9687
Phone (231) 935-0322

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center CurrentSince Aug 5, 2025 Accepting new patients
Munson Medical Center Neurology CurrentSince Aug 5, 2025 Accepting new patients
Major Hospital Past Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

1345 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1740

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

3922 Cedar Run Rd
Traverse City, MI 49684
Phone (231) 392-0430

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

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.

Hospital & facility affiliations 6

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": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1215517438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 W MICHIGAN ST # CL642",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025209",
            "telephone_number": "317-278-2686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W MICHIGAN ST # CL642",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025209",
            "telephone_number": "317-278-2686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1345 E Parkdale Ave",
            "address_purpose": "LOCATION",
            "city": "Manistee",
            "state": "MI",
            "postal_code": "496609318",
            "country_code": "US",
            "telephone_number": "231-398-1750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3922 Cedar Run Rd",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496849687",
            "country_code": "US",
            "telephone_number": "231-392-0430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANTA",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-12",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301513777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.