Individual provider Active NPI

Daniel Evar Edquist, M.D.

  • Family Medicine Physician
  • La Porte, IN
National Provider Identifier
1295723542
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01030213A Issued in IN
Practice address
900 I St
Laporte, IN 46350-5533
Phone
(219) 324-1700
Fax
(219) 324-1602
NPI assigned
Oct 11, 2005
Last updated
Apr 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01030213A IN Primary

Addresses

Primary practice location

900 I St
Laporte, IN 46350-5533

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 3

IdentifierTypeStateIssuer
990012813OtherINRR MEDICARE
100163710MedicaidIN
000000085114OtherINBCBS LAPORTE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address EDQUIST@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01030213AINMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: edquist@mybeacon.cernerdirect.com

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1295723542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 I ST",
            "city": "LAPORTE",
            "state": "IN",
            "postal_code": "463505533",
            "telephone_number": "219-324-1700",
            "fax_number": "219-324-1602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDQUIST",
        "first_name": "DANIEL",
        "middle_name": "EVAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01030213A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "990012813",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100163710",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LAPORTE",
            "identifier": "000000085114",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "EDQUIST@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "900 I St",
            "city": "Laporte",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463505533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in La Porte, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.