Active NPI
Elaine Coghlan, DDS
- Dentist
- Bloomington, IN
National Provider Identifier
1336200054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12008909
- Practice address
- 312 S Swain Avenue
Bloomington, IN 47401-3723 - Phone
- (812) 332-1866
- Fax
- (812) 332-5540
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12008909 | IN | Primary |
Addresses
Primary practice location
312 S Swain Avenue
Bloomington, IN 47401-3723
Mailing address
312 S Swain Avenue
Bloomington, IN 47401-3723
Phone (812) 332-1866
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170606000304 | IN | Order and Referring Only - Oral Surgery | 0941577340 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12008909 | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336200054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 S SWAIN AVENUE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474013723",
"telephone_number": "812-332-1866",
"fax_number": "812-332-5540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 S SWAIN AVENUE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474013723",
"telephone_number": "812-332-1866",
"fax_number": "812-332-5540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COGHLAN",
"first_name": "ELAINE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12008909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.