NPIMap

Individual provider Active NPI

Jon Lee Stockrahm, D.O.

  • Internal Medicine Physician
  • Terre Haute, IN
National Provider Identifier
1962409466
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
02002047 Issued in IN
Practice address
2223 Wabash Ave
Terre Haute, IN 47807-3305
Phone
(812) 235-7252
Fax
(812) 235-7176
NPI assigned
Jun 30, 2005
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 02002047 IN Primary

Addresses

Primary practice location

2223 Wabash Ave
Terre Haute, IN 47807-3305

Mailing address

2223 Wabash Ave
Terre Haute, IN 47807-3305
Phone (812) 235-7252

Other identifiers 4

IdentifierTypeStateIssuer
110232365OtherINRAILROAD MEDICARE
200227720AMedicaidIN
5902718OtherINAETNA
000000211750OtherINANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070601000274 IN Practitioner - Internal Medicine 0244338051 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio University, College of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2223 Wabash Ave
Terre Haute, IN 47807-3305
Phone (812) 235-7610

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02002047INMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine of the Wabash Valley P.C. Internal Medicine CurrentSince Sep 1, 2015 Accepting new patients
Major Hospital Past Accepting new patients
Kepler Inpatient Services Internal Medicine Past Accepting new patients

Locations

1600 E Springhill Dr
Terre Haute, IN 47802
Phone (812) 235-7252

2223 Wabash Ave
Terre Haute, IN 47807
Phone (812) 235-7252

2800 Poplar St
Ste 19A
Terre Haute, IN 47803
Phone (812) 235-7252

Interoperability endpoints

  • Direct secure messaging: jon.stockrahm.1@21799.direct.athenahealth.com

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 9

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1962409466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 WABASH AVE",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478073305",
            "telephone_number": "812-235-7252",
            "fax_number": "812-235-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 WABASH AVE",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478073305",
            "telephone_number": "812-235-7252",
            "fax_number": "812-235-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCKRAHM",
        "first_name": "JON",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02002047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110232365",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200227720A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5902718",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000211750",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

Verify at the official NPI Registry.