Devona R Anderson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01061169A Issued in IN

Practice address

1542 S Dixon Rd Ste B
Kokomo, IN 46902-7319

Phone

(765) 416-1612

Fax

(313) 789-1822

NPI assigned

Nov 7, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2021 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Kharis Recovery Center LLC

  • Primary Care Clinic/Center
  • Noblesville, IN
  • NPI 1255177598
  NPD Authorized official
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• St. Joseph Primary Care, LLC

  • Family Medicine Physician
  • Kokomo, IN
  • NPI 1982736377

  Family Medicine

  NPD (past)
• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537
  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1770564825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 N DELPHOS ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469012565",
            "telephone_number": "765-416-1612",
            "fax_number": "313-789-1822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 S DIXON RD STE B",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469027319",
            "telephone_number": "765-416-1612",
            "fax_number": "313-789-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "DEVONA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01061169A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11517013",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200530410",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maneet Pal Singh Anand, OTR
• Logan Anderson-Dearth
• Amanda Anderson
• Ashlyn Rayanne Anderson, M.S. ED., BCBA
• Carlee Grace Anderson
• Emily Anderson
• Joel Anderson
• John R. Anderson, MA
• Lashelle M Anderson, FNP-C
• Loni Anderson, RBT

• All providers in Kokomo, IN
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.