NPIMap

Organization Active NPI

Family Practice of Jay County

  • Family Medicine Physician
  • Portland, IN
National Provider Identifier
1982749867
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY PRACTICE OF JAY COUNTY
Practice address
428 West Votaw Street, Ste. a
Portland, IN 47371-0710
Phone
(260) 726-8822
Fax
(260) 726-7857
NPI assigned
Feb 20, 2007
Organization subpart
Yes
Parent organization
JAY COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Authorized official

Name
Dr. Mark Allen Haggenjos, D.O.NPI 1619935475
Title
Managing Physician
Phone
(260) 726-8822

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

428 West Votaw Street, Ste. a
Portland, IN 47371-0710

Mailing address

PO Box 710
Portland, IN 47371-0710
Phone (260) 726-8822

Other identifiers 2

IdentifierTypeStateIssuer
200923150MedicaidIN
200326550MedicaidIN

National Provider Directory

National Provider Directory
Part of
Jay County Hosp

Locations

428 W Votaw St
#A
Portland, IN 47371
Phone (260) 726-8822

430 W Votaw St
Ste B
Portland, IN 47371
Phone (260) 726-8822

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1982749867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 710",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473710710",
            "telephone_number": "260-726-8822",
            "fax_number": "260-726-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 WEST VOTAW STREET, STE. A",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473710710",
            "telephone_number": "260-726-8822",
            "fax_number": "260-726-7857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE OF JAY COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JAY COUNTY HOSPITAL",
        "enumeration_date": "2007-02-20",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "HAGGENJOS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "260-726-8822",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200923150",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200326550",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.