Individual provider Active NPI

Varon Cantrell, MD

  • Internal Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1750500070
Registry record updated Sep 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01067875A Issued in IN
Practice address
1522 W Morris St
Indianapolis, IN 46221-1629
Phone
(317) 488-2020
Fax
(317) 488-2031
NPI assigned
Apr 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57010131 OH
Internal Medicine Physician 207R00000X 01067875A IN Primary
Pediatrics Physician 208000000X 01067875A IN

Addresses

Primary practice location

1522 W Morris St
Indianapolis, IN 46221-1629

Mailing address

3401 E Raymond St
Indianapolis, IN 46203-4744
Phone (317) 788-9769

Other identifiers 1

IdentifierTypeStateIssuer
200957170MedicaidIN

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
I20100715000252 IN Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3173679248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Indiana University School of Medicine, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Healthnet IncGroup PAC ID 7214840933, 77 clinicians

Practice addresses (Care Compare)

2855 N Keystone Ave
Indianapolis, IN 46218-2790

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57010131OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthnet, Inc. CurrentSince Jul 30, 2010 Accepting new patients
Major Hospital Past Accepting new patients
University Internal Medicine Associates, Inc. Internal Medicine Past Accepting new patients

Locations

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

1522 W Morris St
Indianapolis, IN 46221
Phone (317) 957-2500

3401 E Raymond St
Indianapolis, IN 46203
Phone (317) 788-9769

2855 N Keystone Ave
Ste 100
Indianapolis, IN 46218
Phone (317) 920-5760

3403 E Raymond St
Indianapolis, IN 46203
Phone (317) 957-2000

3401 E Raymond St
#0
Indianapolis, IN 46203

2855 N Keystone Ave
Ste 130
Indianapolis, IN 46218

6020 Crawfordsville Rd
Ste 102
Speedway, IN 46224
Phone (317) 957-2070

Interoperability endpoints

  • Direct secure messaging: varon.cantrell@hn.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 23

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Martindale Brightwood Health CenterIndianapolis, IN, CCN 151835 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jan 1, 2023
Jun 5, 2023
Southeast Health CenterIndianapolis, IN, CCN 151853 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jan 1, 2019
Peoples Health CenterIndianapolis, IN, CCN 151854 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jun 5, 2023
Southwest Health CenterIndianapolis, IN, CCN 151852 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jan 1, 2019
Tech Teen ClinicIndianapolis, IN, CCN 151887 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jun 5, 2023
Northeast Health CenterIndianapolis, IN, CCN 151902 Federally qualified health center Corporate Officer Jan 1, 2019
Homeless Initiative ProgramIndianapolis, IN, CCN 151916 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jun 5, 2023
Salvation Army Harbor Light Center ClinicIndianapolis, IN, CCN 151948 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jul 15, 2019
Salvation Army Family ShelterIndianapolis, IN, CCN 151950 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jun 5, 2023
Barrington Health CenterIndianapolis, IN, CCN 151981 Federally qualified health center Corporate Officer Jan 1, 2019
Healthnet Bloomington Health CenterBloomington, IN, CCN 151064 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jan 1, 2019
Jun 5, 2023
The Julian Center ClinicIndianapolis, IN, CCN 151079 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jun 5, 2023
Jun 5, 2023
Crispus Attucks ClinicIndianapolis, IN, CCN 151128 Federally qualified health center Corporate Officer Jan 1, 2019
Healthnet Downtown Health CenterIndianapolis, IN, CCN 151133 Federally qualified health center Corporate Director Jan 1, 2019
Healthnet Mobile Health CenterIndianapolis, IN, CCN 151134 Federally qualified health center Corporate Officer Jan 1, 2019
Wheeler Mission Center for Men ClinicBloomington, IN, CCN 151138 Federally qualified health center Corporate Officer Jan 1, 2019
Middle Way House ClinicBloomington, IN, CCN 151196 Federally qualified health center Corporate Officer Jan 1, 2019
Healthnet Speedway Health and Dental CenterIndianapolis, IN, CCN 151879 Federally qualified health center Corporate Officer Jan 1, 2019
Outreach, Inc. ClinicIndianapolis, IN, CCN C51049 Federally qualified health center Corporate Officer
W-2 Managing Employee
Sep 5, 2023
Jun 5, 2023
Healthnet Specialty Care at BarringtonIndianapolis, IN, CCN C51055 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jan 1, 2019
Jan 1, 2019
Crawford Apartments ClinicBloomington, IN, CCN C51057 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jan 1, 2019
Jul 15, 2019
Healthnet Homeless Initiative Program - BloomingtonBloomington, IN, CCN C51066 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jan 1, 2019
Jan 1, 2019
Monroe County Public Library ClinicBloomington, IN, CCN C51071 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jan 1, 2019
Jan 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315440000000",
    "number": "1750500070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 E RAYMOND ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462034744",
            "telephone_number": "317-788-9769",
            "fax_number": "317-781-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 W MORRIS ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462211629",
            "telephone_number": "317-488-2020",
            "fax_number": "317-488-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTRELL",
        "first_name": "VARON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2011-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "57010131",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01067875A",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01067875A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200957170",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.