NPIMap

Individual provider Active NPI

Kristin A Mahan, MD

  • Family Medicine Physician
  • Vincennes, IN
National Provider Identifier
1487622957
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01053104A Issued in IN
Practice address
406 N 1St St
Vincennes, IN 47591-1340
Phone
(812) 882-1106
Fax
(812) 895-2458
NPI assigned
Mar 10, 2006
Last updated
Mar 10, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

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 01053104A IN Primary

Addresses

Primary practice location

406 N 1St St
Vincennes, IN 47591-1340

Mailing address

406 N 1St St
Vincennes, IN 47591-1340
Phone (812) 882-1106

Other identifiers 1

IdentifierTypeStateIssuer
200325700MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100218000135 IN Practitioner - Family Practice 9436293180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

406 N 1St St
Vincennes, IN 47591-1340
Phone (812) 882-1106

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01053104AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Physician Services, Inc Family Medicine CurrentSince Jan 1, 2011 Accepting new patients
Good Samaritan Hospital CurrentSince Jan 1, 2011 Accepting new patients
Good Samaritan Hospital Physicians Services Inc Past Accepting new patients
Good Samaritan Hospital Past Accepting new patients
Open Door Health Services, Inc. Past Accepting new patients

Locations

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

1813 Willow St
Ste 3
Vincennes, IN 47591
Phone (812) 885-8941

406 N 1st St
Vincennes, IN 47591
Phone (812) 882-1106

406 N 1st St
Ste C
Vincennes, IN 47591
Phone (812) 882-1106

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

528 N 1st St
Vincennes, IN 47591
Phone (812) 882-4434

Interoperability endpoints

  • Direct secure messaging: kmahan120915@direct.deaconess.com

Organizations & group practices 5

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 11

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": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1487622957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 N 1ST ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911340",
            "telephone_number": "812-882-1106",
            "fax_number": "812-885-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 N 1ST ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911340",
            "telephone_number": "812-882-1106",
            "fax_number": "812-895-2458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "KRISTIN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01053104A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200325700",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.