Individual provider Active NPI

Rodjawan Supakul, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Carmel, IN
National Provider Identifier
1730463720
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
01088008A Issued in IN
Practice address
11700 N Meridian St
Carmel, IN 46032-4656
Phone
(317) 962-5820
Fax
(317) 962-5841
NPI assigned
Oct 7, 2011
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01088008A IN
Pulmonary Disease Physician 207RP1001X 01088008A IN
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X MD-43716 IA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 01088008A IN Primary

Addresses

Primary practice location

11700 N Meridian St
Carmel, IN 46032-4656

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

855 A Ave NE Ste 400
Cedar Rapids, IA 52402-5064
Phone (319) 363-3565

Other practice location 2

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rsupakul@direct.iuhealth.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221003002040 IN Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 3779852108 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-43716IAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC Multi-Specialty CurrentSince Apr 1, 2025 Accepting new patients
Indiana Clinic Critical Care LLC Multi-Specialty CurrentSince Nov 1, 2022 Accepting new patients

Locations

2574 Reliable Pkwy
Chicago, IL 60686

11700 N Meridian St
Carmel, IN 46032
Phone (317) 688-2000

11725 Illinois St
Ste 465
Carmel, IN 46032
Phone (317) 688-5840

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

1801 Senate Blvd
Ste 230
Indianapolis, IN 46202
Phone (317) 962-5280

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

Interoperability endpoints

  • Direct secure messaging: rsupakul@direct.iuhealth.org
  • Direct secure messaging: rsupakul1@direct.iuhealth.org

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, 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": "1317945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1730463720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11700 N MERIDIAN ST",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324656",
            "telephone_number": "317-962-5820",
            "fax_number": "317-962-5841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "855 A Ave NE Ste 400",
            "address_purpose": "LOCATION",
            "city": "Cedar Rapids",
            "state": "IA",
            "postal_code": "524025064",
            "country_code": "US",
            "telephone_number": "319-363-3565",
            "fax_number": "319-363-4001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "888-484-3258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPAKUL",
        "first_name": "RODJAWAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-07",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01088008A",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IN",
            "license": "01088008A",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IA",
            "license": "MD-43716",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IN",
            "license": "01088008A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rsupakul@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11700 N Meridian St",
            "city": "Carmel",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460324656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.