Individual provider Active NPI

Christy M Loke, DO

  • Pediatrics Physician
  • Lebanon, IN
National Provider Identifier
1851910004
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
02007093A Issued in IN
Practice address
2705 N Lebanon St Ste 415
Lebanon, IN 46052-8621
Phone
(765) 485-8900
Fax
(765) 485-8909
NPI assigned
Apr 8, 2020
Last updated
Oct 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 02007093A IN Primary

Addresses

Primary practice location

2705 N Lebanon St Ste 415
Lebanon, IN 46052-8621

Mailing address

2605 N Lebanon St
Lebanon, IN 46052-1476

Other identifiers 1

IdentifierTypeStateIssuer
300038993MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cloke@withamdirect.org Health Information Exchange (HIE) Witham Memorial Hospital

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
I20200611002908 IN Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 7012339427

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02007093AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Witham Memorial Hospital Past Accepting new patients
Witham Memorial Hospital PastSince Jul 1, 2023 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, 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": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1851910004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST STE 415",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528621",
            "telephone_number": "765-485-8900",
            "fax_number": "765-485-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOKE",
        "first_name": "CHRISTY",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "02007093A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300038993",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cloke@withamdirect.org",
            "affiliation": "Y",
            "affiliationName": "Witham Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2705 N Lebanon St Ste 415",
            "city": "Lebanon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460528621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, IN

Sources for this page

Verify at the official NPI Registry.