Patrick Clifford Logan, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01020481A Issued in IN

Practice address

1910 N Arlington Ave
Indianapolis, IN 46218-5128

Phone

(317) 359-5358

Fax

(317) 359-5358

NPI assigned

Jul 19, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381276800000",
    "number": "1992704290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 N ARLINGTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462185199",
            "telephone_number": "317-359-5358",
            "fax_number": "317-359-5358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 N ARLINGTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462185128",
            "telephone_number": "317-359-5358",
            "fax_number": "317-359-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "PATRICK",
        "middle_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2013-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01020481A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100055560A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "072068448",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eliza Lofton
• Logan Goad DDS LLC
• Amy Jo Logan, PTA
• Andre M Logan
• Madison Logan
• Theodore F Logan, MD
• Farzad Loghmani, MD
• Amy A Logsdon, RN
• Brenda Logsdon, CCC/SLP
• Jennifer Elizabeth Logsdon, RN

• Dermatology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.