NPIMap

Individual provider Active NPI

Mir Fahad Faisal, M.D.

  • Gastroenterology Physician
  • Evansville, IN
National Provider Identifier
1609131614
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01081757A Issued in IN
Practice address
421 Chestnut St
Evansville, IN 47713-1227
Phone
(812) 426-9545
Fax
(812) 858-4512
NPI assigned
Jul 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2012018756 MO
Gastroenterology Physician 207RG0100X 01081757A IN Primary

Addresses

Primary practice location

421 Chestnut St
Evansville, IN 47713-1227

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 426-9545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 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
I20190710002809 IN Practitioner - Gastroenterology 8820392764 Reassigns benefits to 1 organization
I20190821003088 KY Practitioner - Gastroenterology 8820392764 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, shared by 10 NPIs, 411 clinicians

Practice addresses (Care Compare)

340 Starlite Dr
Henderson, KY 42420-6102
Phone (270) 844-8515

421 Chestnut St
Evansville, IN 47713-1227
Phone (812) 426-6645

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy138
Upper gastrointestinal (GI) endoscopy for acid reflux1122

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012018756MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic Inc CurrentSince Jul 1, 2019 Accepting new patients
Methodist Health, Inc. CurrentSince Aug 9, 2019 Accepting new patients
Methodist Health, Inc. Internal Medicine Current Accepting new patients
Deaconess Clinic Inc. Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Methodist Health, Inc. Gastroenterology CurrentSince Aug 9, 2019 Accepting new patients
Deaconess Clinic, Inc Internal Medicine CurrentSince Aug 2, 2019 Accepting new patients
Deaconess Clinic, Inc Past Accepting new patients

Locations

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

4219 Gateway Blvd
Newburgh, IN 47630
Phone (812) 426-9545

4015 Gateway Blvd
Newburgh, IN 47630
Phone (812) 858-6244

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

1305 N Elm St
Ste G
Henderson, KY 42420
Phone (270) 826-0002

1305 N Elm St
Henderson, KY 42420
Phone (270) 827-7100

340 Starlite Dr
Henderson, KY 42420
Phone (270) 212-3070

1700 US Highway 60 W
Morganfield, KY 42437
Phone (270) 389-0031

Interoperability endpoints

  • Direct secure messaging: mfaisal210999@direct.deaconess.com

Organizations & group practices 7

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.

Hospital & facility affiliations 7

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": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1609131614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-426-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 CHESTNUT ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477131227",
            "telephone_number": "812-426-9545",
            "fax_number": "812-858-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAISAL",
        "first_name": "MIR FAHAD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-06",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2012018756",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01081757A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.