Active NPI
Larry T Micon, MD
- Surgery Physician
- Fishers, IN
National Provider Identifier
1700822772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 01031976A
- Practice address
- 13914 Southeastern Pkwy Ste 202
Fishers, IN 46037-7125 - Phone
- (800) 477-0233
- NPI assigned
- Jun 20, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 01031976A | IN | Primary |
Addresses
Primary practice location
13914 Southeastern Pkwy Ste 202
Fishers, IN 46037-7125
Mailing address
10330 N Meridian St # 300
Indianapolis, IN 46290-1024
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100088600 | Medicaid | IN |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University Health Care Associates, Inc | Past | Accepting new patients | |
| Major Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
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- General Practice Physician
- Indianapolis, IN
- NPI 1902032832
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525305600000",
"number": "1700822772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10330 N MERIDIAN ST # 300",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462901024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13914 SOUTHEASTERN PKWY STE 202",
"city": "FISHERS",
"state": "IN",
"postal_code": "460377125",
"telephone_number": "800-477-0233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICON",
"first_name": "LARRY",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2018-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IN",
"license": "01031976A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100088600",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fishers, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.