Individual provider Active NPI

Connie D Harrill, M.D.

  • Diagnostic Radiology Physician
  • Indianapolis, IN
National Provider Identifier
1831132992
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01036841A Issued in IN
Practice address
7340 Shadeland Sta
Suite 200
Indianapolis, IN 46256-3979
Phone
(317) 806-8260
Fax
(317) 806-8296
NPI assigned
Jun 14, 2006
Sex
Female
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
Diagnostic Radiology Physician 2085R0202X 01036841A IN Primary

Addresses

Primary practice location

7340 Shadeland Sta
Suite 200
Indianapolis, IN 46256-3979

Mailing address

7340 Shadeland Sta
Ste 200
Indianapolis, IN 46256-3980
Phone (317) 328-3746

Other identifiers 2

IdentifierTypeStateIssuer
100332610MedicaidIN
000000091479OtherINANTHEM

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 Medicine

State licenses

LicenseStateTypeSpecialty
01036841AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Network, Inc Past Accepting new patients
Madison County Imaging PC Diagnostic Radiology Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1831132992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7340 SHADELAND STA",
            "address_2": "STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462563980",
            "telephone_number": "317-328-3746",
            "fax_number": "317-570-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7340 SHADELAND STA",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462563979",
            "telephone_number": "317-806-8260",
            "fax_number": "317-806-8296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRILL",
        "first_name": "CONNIE",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01036841A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100332610",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000091479",
            "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 Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.