Individual provider Active NPI

Ellen Fan, MD

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1871797134
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01063338A Issued in IN
Practice address
6002 E 38TH St
Indianapolis, IN 46226-5614
Phone
(317) 880-6002
Fax
(317) 880-0417
NPI assigned
Jun 12, 2007
Last updated
Sep 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01063338A IN Primary

Addresses

Primary practice location

6002 E 38TH St
Indianapolis, IN 46226-5614

Mailing address

PO Box 637764
Cincinnati, OH 45263-7764
Phone (317) 880-3939

Other practice location 1

3840 N Sherman Dr
Indianapolis, IN 46226-4462
Phone (317) 541-3400

Other identifiers 2

IdentifierTypeStateIssuer
200876690MedicaidIN
000000541927OtherINANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address efan13805@direct.eskenazihealth.edu

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
I20071019000080 IN Practitioner - Family Practice 2062508260 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Stanford University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eskenazi Medical Group IncGroup PAC ID 4284546813, 134 clinicians

Practice addresses (Care Compare)

720 Eskeanzi Ave
Indianapolis, IN 46202-5166
Phone (317) 880-0000

720 Eskenazi Ave FL
5 OB/GYN Clinic
Indianapolis, IN 46202-5189
Phone (317) 880-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01063338AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Health and Hospital Corporation of Marion County CurrentSince Jan 19, 2014 Accepting new patients
The Health and Hospital Corporation of Marion County Current Accepting new patients
Eskenazi Medical Group Inc CurrentSince Aug 1, 2007 Accepting new patients

Locations

2732 W Michigan St
Indianapolis, IN 46222
Phone (317) 554-4600

3840 N Sherman Dr
Indianapolis, IN 46226
Phone (317) 541-3400

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

6002 E 38th St
Indianapolis, IN 46226
Phone (317) 880-0280

720 Eskenazi Ave
Indianapolis, IN 46202
Phone (317) 880-0000

720 Eskenazi Ave
Fl 2
Indianapolis, IN 46202
Phone (317) 278-5316

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

Interoperability endpoints

  • Direct secure messaging: efan13805@direct.eskenazihealth.edu

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1871797134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 637764",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452637764",
            "telephone_number": "317-880-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6002 E 38TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462265614",
            "telephone_number": "317-880-6002",
            "fax_number": "317-880-0417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3840 N Sherman Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462264462",
            "country_code": "US",
            "telephone_number": "317-541-3400",
            "fax_number": "317-541-3444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "ELLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01063338A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200876690",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000541927",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efan13805@direct.eskenazihealth.edu",
            "affiliation": "N",
            "address_1": "6002 E 38th St",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462265614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.