Active NPI
Thomas G Nill, MD
- Urology Physician
- Fort Wayne, IN
National Provider Identifier
1407820772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 01038992A
- Practice address
- 2512 E Dupont Rd
Suite 100
Fort Wayne, IN 46825-1675 - Phone
- (260) 436-6667
- Fax
- (260) 918-2137
- NPI assigned
- Feb 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 01038992A | IN | Primary |
Addresses
Primary practice location
2512 E Dupont Rd
Suite 100
Fort Wayne, IN 46825-1675
Mailing address
10351 Dawsons Creek Blvd
Ste D
Fort Wayne, IN 46825-1904
Phone (260) 969-1950
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0748972 | Medicaid | OH | |
| 000000087515 | Other | IN | ANTHEM BC/BS |
| 100329810 | Medicaid | IN | |
| 100081380 | Medicaid | IN | |
| 0825398 | Medicaid | OH |
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 |
|---|---|---|---|
| Emergency Physicians of Indiana PC | Past | Accepting new patients |
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.
-
- Emergency Medicine Physician
- Auburn, IN
- NPI 1003869454
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330473600000",
"number": "1407820772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10351 DAWSONS CREEK BLVD",
"address_2": "STE D",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251904",
"telephone_number": "260-969-1950",
"fax_number": "260-918-2137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2512 E DUPONT RD",
"address_2": "SUITE 100",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251675",
"telephone_number": "260-436-6667",
"fax_number": "260-918-2137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NILL",
"first_name": "THOMAS",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2012-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IN",
"license": "01038992A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0748972",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "000000087515",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100329810",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100081380",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0825398",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.