NPIMap

Individual provider Active NPI

Jeremy D Gilliam, MD

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
National Provider Identifier
1538284153
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01064785A Issued in IN
Practice address
5001 US Highway 30 W Ste D
Fort Wayne, IN 46818-9701
Phone
(260) 432-4969
Fax
(260) 432-4969
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R1044 KY
Diagnostic Radiology Physician 2085R0202X 35.091145 OH
Diagnostic Radiology Physician 2085R0202X 01064785A IN Primary

Addresses

Primary practice location

5001 US Highway 30 W Ste D
Fort Wayne, IN 46818-9701

Mailing address

PO Box 80070
Fort Wayne, IN 46898-0070
Phone (260) 432-1568

Other identifiers 3

IdentifierTypeStateIssuer
1538284153MedicaidMI
200939030MedicaidIN
2840742MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080623000222 IN Practitioner - Diagnostic Radiology 8820169600 Reassigns benefits to 4 organizations
I20210510002617 AZ Practitioner - Diagnostic Radiology 8820169600 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry County Memorial HospitalGroup PAC ID 6002724085, 153 clinicians
Greene County General HospitalGroup PAC ID 2961481544, shared by 10 NPIs, 102 clinicians
Summit Radiology P CGroup PAC ID 0143295410, 101 clinicians
Ella E M Brown Charitable CircleGroup PAC ID 1254228745, 172 clinicians
X-Ray Physicians of Shelbyville PCGroup PAC ID 2264420215, 43 clinicians
American Oncology Partners PAGroup PAC ID 0042569758, 377 clinicians

Practice addresses (Care Compare)

1000 N 16TH St
New Castle, IN 47362-4319
Phone (765) 521-0890

1185 N 1000
Linton, IN 47441-5282
Phone 81284722812054

5001 US Hwy 30 W D
Fort Wayne, IN 46818-9701
Phone (260) 432-1568

5051 E Mission Hill Dr
Tucson, AZ 85718-2609
Phone (260) 432-1568

6740 E Maverick Rd
Paradise Valley, AZ 85253-2649
Phone (260) 432-1568

7910 W Jefferson Blvd
Suite 108
Fort Wayne, IN 46804-4159
Phone (260) 436-0800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R1044KYMDDiagnostic Radiology Physician
35.091145OHMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry County Memorial Hospital CurrentSince Mar 18, 2017 Accepting new patients
X-Ray Physicians of Shelbyville PC Diagnostic Radiology CurrentSince Nov 1, 2021 Accepting new patients
Summit Radiology P C Diagnostic Radiology CurrentSince Apr 7, 2014 Accepting new patients
Direct Imaging LLC CurrentSince Jun 16, 2017 Accepting new patients
American Oncology Partners PA Diagnostic Radiology CurrentSince Jan 2, 2025 Accepting new patients
Henry County Memorial Hospital Current Accepting new patients
Greene County General Hospital Diagnostic Radiology CurrentSince Jul 31, 2025 Accepting new patients
Henry County Memorial Hospital CurrentSince Mar 18, 2017 Accepting new patients
Ella E M Brown Charitable Circle Diagnostic Radiology CurrentSince Sep 28, 2024 Accepting new patients
Greene County General Hospital CurrentSince Jul 31, 2025 Accepting new patients
River Valley Imaging, LLC Diagnostic Radiology Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

1120 Professional Blvd
Evansville, IN 47714
Phone (812) 471-7086

7221 Engle Rd
Ste 220
Fort Wayne, IN 46804
Phone 26043215688225

7910 W Jefferson Blvd
Ste 108
Fort Wayne, IN 46804
Phone (219) 484-8830

5001 US Highway 30 W
#D
Fort Wayne, IN 46818
Phone (808) 599-4471

5001 US Highway 30 W
Ste D
Fort Wayne, IN 46818
Phone (260) 469-8273

720 N Lincoln St
Greensburg, IN 47240
Phone (812) 522-2349

8550 Naab Rd
Ste 205
Indianapolis, IN 46260
Phone (317) 338-6040

1185 N 1000 W
Linton, IN 47441
Phone (812) 847-2281

2200 Forest Ridge Pkwy
New Castle, IN 47362
Phone (765) 521-7385

1000 N 16th St
New Castle, IN 47362
Phone (765) 521-0890

2451 Intelliplex Dr
Shelbyville, IN 46176
Phone (317) 392-3211

200 N Madison St
Marshall, MI 49068
Phone (269) 789-3921

Interoperability endpoints

  • Direct secure messaging: jgilliam@yourcarecommunity.org

Organizations & group practices 12

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 5

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": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1538284153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80070",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468980070",
            "telephone_number": "260-432-1568",
            "fax_number": "260-432-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 US HIGHWAY 30 W STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468189701",
            "telephone_number": "260-432-4969",
            "fax_number": "260-432-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "JEREMY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "R1044",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35.091145",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01064785A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538284153",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200939030",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2840742",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.