Individual provider Active NPI

Kenneth Baxter Davis, MD, MBA

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1497514970
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
550 University Blvd
Indianapolis, IN 46202-5149
Phone
(317) 278-7056
NPI assigned
Mar 18, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

550 University Blvd
Indianapolis, IN 46202-5149

Mailing address

13799 Gatsby Dr
Fishers, IN 46038-8405

Other practice location 1

705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Phone (317) 278-7056

Other practice location 2

720 Eskenazi Ave
Indianapolis, IN 46202-5187
Phone (317) 278-7056

Other practice location 3

1701 N Senate Ave
Indianapolis, IN 46202-5306
Phone (317) 278-7056

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20240607002280 FL Order and Referring Only - Diagnostic RadiologyPractitioner - Diagnostic Radiology 8123560919

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: kenneth.davis@hca5.eclinicaldirectplus.com

NPI Registry JSON

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1497514970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13799 GATSBY DR",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460388405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 UNIVERSITY BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025149",
            "telephone_number": "317-278-7056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-278-7056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 Eskenazi Ave",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025187",
            "country_code": "US",
            "telephone_number": "317-278-7056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 N Senate Ave",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025306",
            "country_code": "US",
            "telephone_number": "317-278-7056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KENNETH",
        "middle_name": "BAXTER",
        "name_prefix": "Dr.",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-18",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.