Individual provider Active NPI

Terry J Donovan, MA

  • Audiologist
  • Kokomo, IN
National Provider Identifier
1780660928
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
23001965 Issued in IN
Practice address
931 S Washington St
Kokomo, IN 46901
Phone
(765) 453-0200
Fax
(765) 453-0220
NPI assigned
Dec 20, 2005
Last updated
Jul 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 23001965 IN Primary

Addresses

Primary practice location

931 S Washington St
Kokomo, IN 46901

Mailing address

215 Shuman Blvd Ste 401
Naperville, IL 60563-8123
Phone (630) 303-5380

Other practice location 1

10021 Dupont Circle Ct
Fort Wayne, IN 46825-1604
Phone (260) 426-8117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071005000415 IN Practitioner - Qualified Audiologist 0345335337 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
23001965INMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northland Hearing Centers, Inc. Audiologist CurrentSince Dec 8, 2022 Accepting new patients
Northland Hearing Centers, Inc. Past Accepting new patients
Allied Physicians Inc Past Accepting new patients
Northland Hearing Center, Inc. PastSince Oct 4, 2020 Accepting new patients
Allied Physicians Inc Audiologist Past Accepting new patients

Locations

7726 E US Highway 36
Avon, IN 46123
Phone (317) 272-0455

3843 Moller Rd
Indianapolis, IN 46254
Phone (317) 291-3376

8660 Broadway
Merrillville, IN 46410
Phone (219) 472-0953

6700 Washington Ave S
Eden Prairie, MN 55344
Phone (952) 995-6601

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1780660928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 SHUMAN BLVD STE 401",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638123",
            "telephone_number": "630-303-5380",
            "fax_number": "630-303-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 S WASHINGTON ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "46901",
            "telephone_number": "765-453-0200",
            "fax_number": "765-453-0220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10021 Dupont Circle Ct",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468251604",
            "country_code": "US",
            "telephone_number": "260-426-8117",
            "fax_number": "260-420-0817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "TERRY",
        "middle_name": "J",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23001965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.