Active NPI
Theodora E Jenkins, DO
- Family Medicine Physician
- Indianapolis, IN
National Provider Identifier
1720199524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02001255A
- Practice address
- 650 N Girls School Rd
Indianapolis, IN 46214-3672 - Phone
- (317) 271-5080
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02001255A | IN | Primary |
Addresses
Primary practice location
650 N Girls School Rd
Indianapolis, IN 46214-3672
Mailing address
PO Box 4780
Bloomington, IN 47402-4780
Phone (812) 336-1690
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02001255A | Other | IN | IN LICENSE |
| 02001255B | Other | IN | CSR |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02001255A | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1720199524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4780",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474024780",
"telephone_number": "812-336-1690",
"fax_number": "812-349-1311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 N GIRLS SCHOOL RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462143672",
"telephone_number": "317-271-5080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "THEODORA",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "02001255A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IN LICENSE",
"identifier": "02001255A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSR",
"identifier": "02001255B",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.