Individual provider Active NPI

Jeffrey R McIntyre, D. C.

  • Chiropractor
  • Anderson, IN
National Provider Identifier
1376772525
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
08002470A Issued in IN
Practice address
1541 S Scatterfield Rd
Ste a
Anderson, IN 46016-5784
Phone
(765) 649-1991
Fax
(765) 649-3383
NPI assigned
Jul 9, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 08002470A IN Primary

Addresses

Primary practice location

1541 S Scatterfield Rd
Ste a
Anderson, IN 46016-5784

Mailing address

407 E Market St
Ste 102
Crawfordsville, IN 47933-1852
Phone (765) 362-1500

Other identifiers 3

IdentifierTypeStateIssuer
200959690MedicaidIN
000000729295OtherINANTHEM INDIVIDUAL PIN
M400055076OtherINMEDICARE PTAN INDIVIDUAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091014000363 IN Practitioner - Chiropractic 6507902087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chiromed Plus LLC 3 clinicians

Practice addresses (Care Compare)

407 E Market St
Suite 102
Crawfordsville, IN 47933-1852
Phone (765) 362-1500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
08002470AINMDChiropractor

Organizations & group practices 1

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": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1376772525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E MARKET ST",
            "address_2": "STE 102",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331852",
            "telephone_number": "765-362-1500",
            "fax_number": "765-361-8919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 S SCATTERFIELD RD",
            "address_2": "STE A",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460165784",
            "telephone_number": "765-649-1991",
            "fax_number": "765-649-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTYRE",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D. C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-09",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08002470A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200959690",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM INDIVIDUAL PIN",
            "identifier": "000000729295",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN INDIVIDUAL",
            "identifier": "M400055076",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.