Active NPI
Thomas Brooks Logan, M.D.
- Otolaryngology Physician
- Henderson, KY
National Provider Identifier
1508854431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 14807
- Practice address
- 800 N Elm St
Henderson, KY 42420-2709 - Phone
- (812) 499-9948
- NPI assigned
- Oct 13, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 01029120A | IN | |
| Otolaryngology Physician | 207Y00000X | 14807 | KY | Primary |
Addresses
Primary practice location
800 N Elm St
Henderson, KY 42420-2709
Mailing address
1020 Professional Boulevard
Evansville, IN 47714-8009
Phone (812) 473-2060
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000181609 | Other | IN | ANTHEM |
| 110013 | Other | IN | HEALTHLINK |
| 100246610A | Medicaid | IN | |
| 064946 | Other | IN | HEALTH ALLIANCE |
| 000000181609 | Other | KY | ANTHEM |
| 64148075 | Medicaid | KY |
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
Interoperability endpoints
- tlogan@midwestentdoctors.gwaydirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589932800000",
"number": "1508854431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 PROFESSIONAL BOULEVARD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477148009",
"telephone_number": "812-473-2060",
"fax_number": "812-473-0763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N ELM ST",
"city": "HENDERSON",
"state": "KY",
"postal_code": "424202709",
"telephone_number": "812-499-9948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "THOMAS",
"middle_name": "BROOKS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-13",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IN",
"license": "01029120A",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "KY",
"license": "14807",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000181609",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "110013",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100246610A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "064946",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000181609",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64148075",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.