Active NPI
Timothy E. Davis, M.D.
- Family Medicine Physician
- Elkhart, IN
National Provider Identifier
1356344204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01027755A
- Practice address
- 303 S Nappanee St
Elkhart, IN 46514-2066 - Phone
- (574) 296-3955
- Fax
- (574) 296-3999
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Family Medicine) Physician | 207QA0401X | 01027755A | IN | |
| Family Medicine Physician | 207Q00000X | 01027755A | IN | Primary |
Addresses
Primary practice location
303 S Nappanee St
Elkhart, IN 46514-2066
Mailing address
PO Box 2968
Elkhart, IN 46515-2968
Phone (574) 296-3955
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100348240A | Medicaid | IN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 01027755A | IN | MD | Addiction Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244505600000",
"number": "1356344204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2968",
"city": "ELKHART",
"state": "IN",
"postal_code": "465152968",
"telephone_number": "574-296-3955",
"fax_number": "574-296-3999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 S NAPPANEE ST",
"city": "ELKHART",
"state": "IN",
"postal_code": "465142066",
"telephone_number": "574-296-3955",
"fax_number": "574-296-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "TIMOTHY",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2009-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0401X",
"taxonomy_group": "",
"desc": "Family Medicine, Addiction Medicine",
"state": "IN",
"license": "01027755A",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01027755A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100348240A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.