Jonathon Wade Cavins, M.D.
Individual provider Active NPI Pediatrics Physician · Lebanon, IN
NPI 1407066384 · NPPES record last updated Jul 21, 2022
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Apr 20, 2021.
Key facts
- NPI
- 1407066384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 01064975A (IN)
- Practice address
- 2705 N Lebanon St Ste 310
Lebanon, IN 46052-8622 - Phone
- (765) 485-8900
- Fax
- (765) 485-8909
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01064975A | IN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Witham Memorial Hospital | Past | Accepting new patients | |
| Witham Memorial Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01064975A | IN | Yes |
Addresses
Primary practice location
2705 N Lebanon St Ste 310
Lebanon, IN 46052-8622
Mailing address
2705 N Lebanon St Ste 305
Lebanon, IN 46052-8622
Phone (765) 485-8852
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200908670 | Medicaid | IN |
Other providers in Lebanon, IN
- Cartwright Dental LLC
- Jeff Cartwright
- Thomas Ray Cartwright
- Anahi Castro
- Jarod Ryan Cates
- CG-Dsa, LLC
- CG-Dsa, LLC
- Lilly Chapman
- Kimra M Cheek
- Zachary Childers
All providers in Lebanon, IN · Pediatrics Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- OIG LEIE (HHS Office of Inspector General).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.