Active NPI
Gordon Daniel Welk, MD
- Emergency Medicine Physician
- West Lafayette, IN
National Provider Identifier
1912966748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 01025175A
- Practice address
- 253 Sagamore Pkwy W
West Lafayette, IN 47906-1501 - Phone
- (765) 448-8000
- Fax
- (765) 446-7023
- NPI assigned
- Mar 21, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01025175A | IN | |
| Emergency Medicine Physician | 207P00000X | 01025175A | IN | Primary |
Addresses
Primary practice location
253 Sagamore Pkwy W
West Lafayette, IN 47906-1501
Mailing address
PO Box 5545
Lafayette, IN 47903-5545
Phone (765) 448-8000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000189493 | Other | IN | UC ANTHEM PROVIDER NUMBER |
| 000000341035 | Other | IN | FP ANTHEM PROVIDER NUMBER |
| 10826167 | Other | IN | CAQH NUMBER |
| 100117190 | Medicaid | IN | |
| 9038773 | Other | IN | PHCS PID NUMBER |
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 |
|---|---|---|---|
| 01025175A | IN | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456099200000",
"number": "1912966748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5545",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479035545",
"telephone_number": "765-448-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "253 SAGAMORE PKWY W",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479061501",
"telephone_number": "765-448-8000",
"fax_number": "765-446-7023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELK",
"first_name": "GORDON",
"middle_name": "DANIEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2016-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01025175A",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "01025175A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UC ANTHEM PROVIDER NUMBER",
"identifier": "000000189493",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FP ANTHEM PROVIDER NUMBER",
"identifier": "000000341035",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH NUMBER",
"identifier": "10826167",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100117190",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS PID NUMBER",
"identifier": "9038773",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.