Active NPI
Daniel Fagan, MD
- Internal Medicine Physician
- Indianapolis, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01041566A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200013910 | Medicaid | IN | |
| 000000363213 | Other | IN | ANTHEM |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01041566A | IN | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Family Physicians, Inc. | Current | Accepting new patients | |
| University Family Physicians, Inc. | Internal Medicine | Current | Accepting new patients |
| Indiana University Health Care Associates, Inc | Current | 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.
-
- General Practice Physician
- Indianapolis, IN
- NPI 1902032832
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1043275787
Internal Medicine
-
- Durable Medical Equipment & Medical Supplies
- Indianapolis, IN
- NPI 1669828042
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
-
- Internal Medicine Physician
- Indianapolis, IN
- NPI 1861441537
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.