Active NPI
Erik S Fossum, MD
- Emergency Medicine Physician
- Indianapolis, IN
National Provider Identifier
1396062899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 01070394A
- Practice address
- 1701 N Senate Blvd
Room Dg412
Indianapolis, IN 46202-1239 - Phone
- (317) 962-3886
- Fax
- (317) 963-5492
- NPI assigned
- Apr 23, 2010
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Emergency Medicine Physician | 207P00000X | 01070394A | IN | Primary |
Addresses
Primary practice location
1701 N Senate Blvd
Room Dg412
Indianapolis, IN 46202-1239
Mailing address
950 N. Meridian Street
Ste 500
Indianapolis, IN 46204-3908
Phone (317) 962-4942
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201101250 | 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University Health Care Associates, Inc | Past | Accepting new patients | |
| University Medical Diagnostic Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba IU Health Physicians
- General Practice Physician
- Indianapolis, IN
- NPI 1902032832
-
- Internal Medicine Physician
- Indianapolis, IN
- NPI 1861441537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373414400000",
"number": "1396062899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 N. MERIDIAN STREET",
"address_2": "STE 500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462043908",
"telephone_number": "317-962-4942",
"fax_number": "317-962-4950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 N SENATE BLVD",
"address_2": "ROOM DG412",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462021239",
"telephone_number": "317-962-3886",
"fax_number": "317-963-5492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSSUM",
"first_name": "ERIK",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-23",
"last_updated": "2013-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "01070394A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201101250",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.