NPIMap

Individual provider Active NPI

Timothy Michael Eisenhut, MD

  • Pediatrics Physician
  • Indianapolis, IN
National Provider Identifier
1396832887
Registry record updated Jan 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01033758A Issued in IN
Practice address
6640 Parkdale Place
Suite U
Indianapolis, IN 46254-4698
Phone
(317) 291-5190
Fax
(317) 291-1510
NPI assigned
Oct 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01033758A IN Primary

Addresses

Primary practice location

6640 Parkdale Place
Suite U
Indianapolis, IN 46254-4698

Mailing address

6640 Parkdale Place
Suite U
Indianapolis, IN 46254-4698
Phone (317) 291-5190

Other identifiers 2

IdentifierTypeStateIssuer
100228800MedicaidIN
000000087000OtherANTHEM

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01033758AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penny W. Kallmyer, M.D., P.C. Pediatrics Past Accepting new patients
Timothy M Eisenhut MD Pediatrics Past Accepting new patients
Major Hospital Past Accepting new patients

Organizations & group practices 3

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1396832887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 PARKDALE PLACE",
            "address_2": "SUITE U",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544698",
            "telephone_number": "317-291-5190",
            "fax_number": "317-291-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 PARKDALE PLACE",
            "address_2": "SUITE U",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544698",
            "telephone_number": "317-291-5190",
            "fax_number": "317-291-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENHUT",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01033758A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100228800",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000087000",
            "state": null
        }
    ],
    "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 Jan 30, 2019; 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.