Individual provider Active NPI

Dominic James Vernon, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1851737803
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
01082463A Issued in IN
Practice address
1130 W Michigan St Ste 400
Indianapolis, IN 46202-5209
Phone
(317) 944-5000
NPI assigned
May 17, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 01082463A IN
Otolaryngology Physician 207Y00000X D84871 MD
Student in an Organized Health Care Education/Training Program 390200000X
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 01082463A IN Primary

Addresses

Primary practice location

1130 W Michigan St Ste 400
Indianapolis, IN 46202-5209

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other identifiers 2

IdentifierTypeStateIssuer
000001300219OtherINANTHEM PTAN
300029615MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dvernon@direct.iuhealth.org

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
I20190829001372 IN Practitioner - Otolaryngology 5294976882 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Indiana University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision13
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D84871MDMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Otolaryngology Associates, Inc. Otolaryngology CurrentSince Aug 20, 2019 Accepting new patients
Iu Health Medical Group, LLC CurrentSince Oct 1, 2024 Accepting new patients

Locations

7631 Solutions Ctr
Chicago, IL 60677

1115 Ronald Reagan Pkwy
Ste 254
Avon, IN 46123
Phone (317) 705-2700

1111 Ronald Reagan Pkwy
Rm 12028
Avon, IN 46123
Phone (317) 217-3257

1115 Ronald Reagan Pkwy
Avon, IN 46123
Phone (317) 217-2500

1130 W Michigan St
Ste 400
Indianapolis, IN 46202
Phone (317) 278-1219

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

Interoperability endpoints

  • Direct secure messaging: dvernon14910@direct.eskenazihealth.edu

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1851737803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W MICHIGAN ST STE 400",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025209",
            "telephone_number": "317-944-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERNON",
        "first_name": "DOMINIC",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-17",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01082463A",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": "D84871",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "IN",
            "license": "01082463A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PTAN",
            "identifier": "000001300219",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300029615",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dvernon@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "1130 W Michigan St Ste 400",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462025209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.