Individual provider Active NPI

Quentin B Emerson, M.D.

  • Family Medicine Physician
  • Fort Branch, IN
National Provider Identifier
1427065341
Registry record updated Mar 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01027038 Issued in IN
Practice address
7861 S Professional Dr
Fort Branch, IN 47648-8405
Phone
(812) 753-4181
Fax
(812) 753-4399
NPI assigned
Aug 2, 2006
Last updated
Mar 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01027038 IN Primary

Addresses

Primary practice location

7861 S Professional Dr
Fort Branch, IN 47648-8405

Mailing address

PO Box 185
Fort Branch, IN 47648-0185
Phone (812) 753-4181

Other identifiers 1

IdentifierTypeStateIssuer
100122120MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080805000506 IN Practitioner - Family Practice 3577536911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1975
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

7861 S Professional Dr
Ft Branch, IN 47648-8405
Phone (812) 753-4181

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue45
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01027038INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Gibson Medical Clinic Inc. Family Medicine CurrentSince Jun 19, 2008 Accepting new patients

Locations

7861 S Professional Dr
Fort Branch, IN 47648
Phone (812) 753-4181

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552262400000",
    "number": "1427065341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 185",
            "city": "FORT BRANCH",
            "state": "IN",
            "postal_code": "476480185",
            "telephone_number": "812-753-4181",
            "fax_number": "812-753-4399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7861 S PROFESSIONAL DR",
            "city": "FORT BRANCH",
            "state": "IN",
            "postal_code": "476488405",
            "telephone_number": "812-753-4181",
            "fax_number": "812-753-4399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMERSON",
        "first_name": "QUENTIN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2019-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01027038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100122120",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Branch, IN

Sources for this page

Verify at the official NPI Registry.