Active NPI
Jeffrey Alan Campbell, M.D.
- Family Medicine Physician
- Jeffersonville, IN
National Provider Identifier
1518063585
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jul 18, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01036153
- Practice address
- 1804 E 10TH St
Jeffersonville, IN 47130-6016 - Phone
- (812) 288-2488
- Fax
- (812) 288-6603
- NPI assigned
- Sep 16, 2006
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01036153 | IN | Primary |
| Family Medicine Physician | 207Q00000X | 23424 | KY | |
| Addiction Medicine (Family Medicine) Physician | 207QA0401X | 23424 | KY | |
| Addiction Medicine (Anesthesiology) Physician | 207LA0401X | 23424 | KY | |
| Addiction Medicine (Anesthesiology) Physician | 207LA0401X | 01036153A | IN |
Addresses
Primary practice location
1804 E 10TH St
Jeffersonville, IN 47130-6016
Mailing address
1804 E 10TH St
Jeffersonville, IN 47130-6016
Phone (812) 288-2488
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080067815 | Other | IN | PALMETTO |
| 100464320 | Medicaid | IN | |
| 1195507 | Other | IN | CHA HEALTH |
| 000000050807 | Other | IN | ANTHEM |
| 004272 | Other | IN | SIHO |
| 1018897 | Other | IN | CHAMPUS |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23424 | KY | MD | Addiction Medicine (Anesthesiology) Physician |
| 01036153 | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457049600000",
"number": "1518063585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 E 10TH ST",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471306016",
"telephone_number": "812-288-2488",
"fax_number": "812-288-6603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1804 E 10TH ST",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471306016",
"telephone_number": "812-288-2488",
"fax_number": "812-288-6603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "JEFFREY",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2016-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01036153",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "23424",
"primary": false
},
{
"code": "207QA0401X",
"taxonomy_group": "",
"desc": "Family Medicine, Addiction Medicine",
"state": "KY",
"license": "23424",
"primary": false
},
{
"code": "207LA0401X",
"taxonomy_group": "",
"desc": "Anesthesiology, Addiction Medicine",
"state": "KY",
"license": "23424",
"primary": false
},
{
"code": "207LA0401X",
"taxonomy_group": "",
"desc": "Anesthesiology, Addiction Medicine",
"state": "IN",
"license": "01036153A",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO",
"identifier": "080067815",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100464320",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA HEALTH",
"identifier": "1195507",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000050807",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO",
"identifier": "004272",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "1018897",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jeffersonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.