Active NPI
Annette C Douglas, M.D.
- Diagnostic Radiology Physician
- Indianapolis, IN
National Provider Identifier
1861431207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 01056651
- Practice address
- 8714 Sargent Creek LN
Indianapolis, IN 46256-1376 - Phone
- (952) 595-1100
- Fax
- (612) 294-4903
- NPI assigned
- Jun 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | 01056651 | IN | |
| Diagnostic Radiology Physician | 2085R0202X | 01056651 | IN | Primary |
Addresses
Primary practice location
8714 Sargent Creek LN
Indianapolis, IN 46256-1376
Mailing address
11995 Singletree LN
Ste 500
Eden Prairie, MN 55344-5347
Phone (952) 595-1301
Other names 1
- Annette C Akinwande
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
| License | State | Type | Specialty |
|---|---|---|---|
| 01056651 | IN | MD | Neuroradiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana Radiology Partners, Inc | Neuroradiology | Past | Accepting new patients |
| Indiana University Health, Inc | 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.
-
- Diagnostic Radiology Physician
- Indianapolis, IN
- NPI 1497712160
Neuroradiology
-
- Cardiovascular Disease Physician
- Indianapolis, IN
- NPI 1376586719
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1861431207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11995 SINGLETREE LN",
"address_2": "STE 500",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553445347",
"telephone_number": "952-595-1301",
"fax_number": "612-294-4903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8714 SARGENT CREEK LN",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462561376",
"telephone_number": "952-595-1100",
"fax_number": "612-294-4903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "ANNETTE",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-04",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "IN",
"license": "01056651",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IN",
"license": "01056651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ANNETTE",
"last_name": "AKINWANDE",
"middle_name": "C",
"code": "1",
"type": "Former Name"
}
]
}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 Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.