Individual provider Active NPI

Timothy Matthew Snyder, MD

  • Pediatrics Physician
  • West Lafayette, IN
National Provider Identifier
1508828880
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01038504A Issued in IN
Practice address
915 Sagamore Pkwy W
West Lafayette, IN 47906-1443
Phone
(765) 463-2424
Fax
(765) 463-2249
NPI assigned
Apr 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01038504A IN Primary

Addresses

Primary practice location

915 Sagamore Pkwy W
West Lafayette, IN 47906-1443

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other identifiers 3

IdentifierTypeStateIssuer
000000782957OtherANTHEM
100101850MedicaidIN
10786209OtherCAQH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tsnyder55343@Direct.FranciscanAlliance.org Direct

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
I20061006000586 IN Practitioner - Pediatric Medicine 9931105343 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01038504AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Apr 8, 2012 Accepting new patients
Franciscan Physician Network CurrentSince Apr 8, 2012 Accepting new patients
Franciscan Physician Network Current Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1040 Sierra Dr
Ste 400
Greenwood, IN 46143
Phone (317) 528-4886

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

915 Sagamore Pkwy W
West Lafayette, IN 47906
Phone (765) 463-2424

Interoperability endpoints

  • Direct secure messaging: tsnyder55343@direct.franciscanalliance.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1508828880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061443",
            "telephone_number": "765-463-2424",
            "fax_number": "765-463-2249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNYDER",
        "first_name": "TIMOTHY",
        "middle_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01038504A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000782957",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100101850",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10786209",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tsnyder55343@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "915 Sagamore Pkwy W",
            "city": "West Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479061443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Lafayette, IN

Sources for this page

Verify at the official NPI Registry.