Individual provider Active NPI

Megan Lynn Kelly Dake, PA

  • Surgical Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1235480724
Registry record updated Jun 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10001467A Issued in IN
Practice address
8433 Harcourt Rd Ste 100
Indianapolis, IN 46260-2193
Phone
(317) 583-7600
NPI assigned
Sep 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10001467A IN
Surgical Physician Assistant 363AS0400X 10001467A IN Primary

Addresses

Primary practice location

8433 Harcourt Rd Ste 100
Indianapolis, IN 46260-2193

Mailing address

8433 Harcourt Rd Ste 100
Indianapolis, IN 46260-2193

Other names 1

  • Megan Lynn Kelly Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address megan.lynn.kelly.dake.1@7598.direct.athenahealth.com St. Vincent Medical Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20121212000343 IN Practitioner - Physician Assistant 2264684505 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Medical Group, Inc. CurrentSince Nov 26, 2012 Accepting new patients
St. Vincent Medical Group, Inc. CurrentSince Nov 26, 2012 Accepting new patients
St Vincent Medical Group Inc Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

9166 E US Highway 36
Avon, IN 46123
Phone (317) 415-5300

8333 Naab Rd
Ste 400
Indianapolis, IN 46260
Phone (317) 338-5066

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

8333 Naab Rd
Ste 250
Indianapolis, IN 46260
Phone (317) 338-5100

8433 Harcourt Rd
Ste 100
Indianapolis, IN 46260
Phone (317) 583-7702

3900 St Francis Way
Ste 201
Lafayette, IN 47905
Phone (765) 400-0204

Interoperability endpoints

  • Direct secure messaging: megan.lynn.kelly.dake.1@7598.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1235480724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8433 HARCOURT RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8433 HARCOURT RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602193",
            "telephone_number": "317-583-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAKE",
        "first_name": "MEGAN",
        "middle_name": "LYNN KELLY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001467A",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10001467A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "megan.lynn.kelly.dake.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "8433 Harcourt Rd Ste 100",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462602193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MEGAN",
            "last_name": "KELLY",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.