NPIMap

Individual provider Active NPI

Timothy L Davis, MD PHD

  • Diagnostic Radiology Physician
  • Indianapolis, IN
National Provider Identifier
1710977566
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01053844A Issued in IN
Practice address
5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone
(317) 328-5050
Fax
(317) 715-9965
NPI assigned
Oct 24, 2005
Last updated
Mar 18, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01053844A IN Primary

Addresses

Primary practice location

5901 Technology Center Dr
Indianapolis, IN 46278-6013

Mailing address

5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone (317) 328-5050

Other identifiers 7

IdentifierTypeStateIssuer
Q0417073OtherINCMOSHO351158723&352047427
200427660MedicaidIN
000000492340OtherINANTHEM 203778927
108054OtherINHEALTH ALLIANCE-351158723
000000260995OtherINANTHEM-351158723
021382OtherINSIHO-351158723
300139049OtherINRR MEDICARE-351158723

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190514002850 CA Practitioner - Diagnostic Radiology 5294709390 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Harvard Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

Shell Beach, CA 93449
Phone (805) 461-7080

1154 E Grand Ave
Arroyo Grande, CA 93420-2583
Phone (805) 395-3277

262 Posada LN
Templeton, CA 93465-4057
Phone (805) 434-1491

77 Casa St
Suite 102
San Luis Obispo, CA 93405-5804
Phone (805) 546-7733

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01053844AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magnetic Resonance Imaging of San Luis Obispo, Inc. Diagnostic Radiology CurrentSince Mar 1, 2019 Accepting new patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Jul 1, 2025 Accepting new patients
Adventist Health Physicians Network Diagnostic Radiology CurrentSince Jul 1, 2025 Accepting new patients
Radiology Associates of San Luis Obispo, a Medical Group Inc Diagnostic Radiology CurrentSince Jan 1, 2024 Accepting new patients
St Vincent Northwest Radiology LLC Diagnostic Radiology Past Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients
Rush Memorial Hospital Past Accepting new patients
St. Vincent Health Wellness and Preventive Care Institute, Inc. Past Accepting new patients
St. Vincent Jennings Hospital, Inc. Past Accepting new patients

Locations

1154 E Grand Ave
Arroyo Grande, CA 93420
Phone (805) 395-3277

77 Casa St
Ste 102
Sn Luis Obisp, CA 93405
Phone (805) 546-7698

1310 Las Tablas Rd
Ste 103
Templeton, CA 93465
Phone (805) 434-0829

Organizations & group practices 10

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 4

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": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1710977566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-715-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-715-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TIMOTHY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01053844A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMOSHO351158723&352047427",
            "identifier": "Q0417073",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200427660",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM 203778927",
            "identifier": "000000492340",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE-351158723",
            "identifier": "108054",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-351158723",
            "identifier": "000000260995",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO-351158723",
            "identifier": "021382",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE-351158723",
            "identifier": "300139049",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.