Individual provider Active NPI

Daniel Fagan, MD

  • Internal Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1831156330
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01041566A Issued in IN
Practice address
1520 N Senate Ave
Indianapolis, IN 46202-2213
Phone
(317) 962-8893
Fax
(317) 962-1048
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01041566A IN Primary

Addresses

Primary practice location

1520 N Senate Ave
Indianapolis, IN 46202-2213

Mailing address

250 N Shadeland Ave
Ste 130 - Provider Enrollment
Indianapolis, IN 46219-4959

Other identifiers 2

IdentifierTypeStateIssuer
200013910MedicaidIN
000000363213OtherINANTHEM

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
I20050601000731 IN Practitioner - Internal Medicine 8022050988 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01041566AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Family Physicians, Inc. CurrentSince Apr 1, 2012 Accepting new patients
University Family Physicians, Inc. Internal Medicine CurrentSince Apr 1, 2012 Accepting new patients
Indiana University Health Care Associates, Inc CurrentSince Jan 1, 2015 Accepting new patients
Major Hospital Past Accepting new patients
University Medical Diagnostic Associates, Inc. Internal Medicine Past Accepting new patients

Locations

5208 Reliable Pkwy
Chicago, IL 60686

7216 Solutions Ctr
Chicago, IL 60677

2625 E 62nd St
Ste 2010
Indianapolis, IN 46220
Phone (317) 251-6121

1633 N Capitol Ave
Ste 640
Indianapolis, IN 46202
Phone (317) 962-6335

250 N Shadeland Ave
Ste 130
Indianapolis, IN 46219
Phone (317) 962-4836

5515 W 38th St
Indianapolis, IN 46254
Phone (317) 880-3838

250 University Blvd
Indianapolis, IN 46202
Phone (317) 274-8580

1520 N Senate Ave
Indianapolis, IN 46202
Phone (317) 962-0857

1701 N Senate Blvd
Bldg C6
Indianapolis, IN 46202
Phone (913) 962-2000

720 Eskenazi Ave
Fl 5
Indianapolis, IN 46202
Phone (317) 880-6000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423440000000",
    "number": "1831156330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "STE 130 - PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022213",
            "telephone_number": "317-962-8893",
            "fax_number": "317-962-1048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2015-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01041566A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200013910",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000363213",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.