Active NPI 1881690790 Individual Practitioner Male Practitioner

Dr. Jeffrey David Wagner , MD

Plastic Surgery • Indianapolis, IN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jeffrey Wagner, MD is a certified Plastic Surgery practicing in Indianapolis, IN. With approximately 40 years of clinical experience since graduating from University Of Minnesota Medical School in 1986, Dr. Wagner delivers high-quality medical care to the local community at 8040 CLEARVISTA PKWY STE 520.

Dr. Wagner maintains professional affiliations with Community Physicians Of Indiana Inc, Community Physician Network Specialty Care Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include new patient outpatient office visit, lymph node imaging during surgery, removal of cancer skin growth of body, arms, or legs, more than 4.0 cm. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

8040 Clearvista Pkwy Ste 520

Indianapolis, IN 462565604

Telephone 3176219470

Associated Practice Facility / Clinic

🏢 Your Wellness Choice Llc Facility NPI 1093269334

Medicare Profile & Education

Medical School

University Of Minnesota Medical School

Graduation Year

1986

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Plastic Surgery in Indianapolis, IN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

40 Yrs +15.8 yrs vs City Avg

City Avg: 24.2 Yrs

State Avg: 25.7 Yrs

Regional Practice Density

32 Specialists

Practicing in Indianapolis, IN (84 Statewide)

Telehealth Adoption Rate

3.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

69.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Wagner (40 Years) 40 Yrs

Indianapolis Specialty Average (24.2 Years) 24.2 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	111	111	$164.00	$105.71
38900 Lymph node imaging during surgery	85	85	$336.97	$126.92
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	67	67	$249.00	$159.29
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	52	51	$770.00	$170.24
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	43	43	$1130.74	$421.56
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	39	39	$643.00	$172.56
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	37	33	$180.00	$65.85
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	36	34	$207.00	$77.35
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	35	35	$608.00	$151.98
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	33	32	$518.00	$113.84
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	30	30	$756.00	$239.12
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	22	$72.00	$54.24
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	21	21	$471.00	$100.52
38510 Biopsy or removal of deep lymph nodes of neck	21	21	$1019.00	$306.09
13133 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, each additional 5.0 cm or less	19	19	$317.00	$117.99
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	18	18	$498.00	$124.84
99213 Established patient office or other outpatient visit, typically 15 minutes	16	15	$143.00	$84.66
38531 Biopsy or removal of lymph nodes of groin	15	15	$1067.00	$361.92
38500 Biopsy or removal of lymph nodes, open procedure	14	14	$594.96	$118.93
11626 Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals	13	13	$712.00	$136.42
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	13	13	$1683.00	$623.41
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	12	12	$555.00	$107.64
11624 Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals	12	12	$578.00	$112.63

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	97	97	$164.00	$102.16
38900 Lymph node imaging during surgery	73	73	$335.00	$121.21
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	62	62	$249.00	$154.52
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	52	51	$643.00	$178.26
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	51	41	$207.00	$75.50
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	32	32	$1057.00	$384.74
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	32	25	$180.00	$65.32
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	32	31	$770.00	$166.69
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	31	30	$756.00	$228.29
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	27	27	$608.00	$160.15
38510 Biopsy or removal of deep lymph nodes of neck	24	24	$1019.00	$270.81
13133 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, each additional 5.0 cm or less	24	21	$317.00	$111.05
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	23	23	$471.00	$86.65
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	21	20	$72.00	$52.24
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	21	21	$518.00	$97.64
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	18	18	$555.00	$94.75
11626 Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals	15	15	$712.00	$141.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	77	77	$146.77	$103.19
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	57	57	$210.93	$156.16
38900 Lymph node imaging during surgery	43	43	$768.02	$125.39
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	42	41	$854.98	$193.51
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	40	38	$559.95	$76.34
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	32	32	$757.94	$98.41
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	28	28	$924.29	$171.94
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	25	25	$1355.20	$362.91
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	22	22	$668.00	$182.31
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	20	19	$1347.20	$256.78
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	20	19	$228.40	$66.50
99213 Established patient office or other outpatient visit, typically 15 minutes	17	15	$96.47	$81.92
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	14	14	$565.86	$95.37
38510 Biopsy or removal of deep lymph nodes of neck	12	12	$1154.75	$242.00
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	11	11	$66.55	$52.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	86	86	$138.00	$106.30
38900 Lymph node imaging during surgery	77	76	$1000.00	$126.53
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	75	75	$187.00	$159.48
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	48	46	$950.00	$179.03
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	41	41	$768.29	$78.49
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	38	37	$1067.37	$176.10
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	38	37	$1635.79	$351.50
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	34	33	$892.50	$100.16
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	31	31	$740.00	$190.40
38510 Biopsy or removal of deep lymph nodes of neck	31	31	$1238.71	$251.42
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	30	30	$66.00	$51.71
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	27	27	$301.00	$68.13
99213 Established patient office or other outpatient visit, typically 15 minutes	22	22	$80.00	$80.51
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	19	19	$637.00	$95.60
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	18	17	$2329.00	$581.05
11626 Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals	17	17	$1165.00	$137.08
10160 Aspiration of abscess, blood accumulation, blister, or cyst	16	11	$188.00	$99.98
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	15	15	$3846.00	$814.64
38500 Biopsy or removal of lymph nodes, open procedure	14	14	$750.00	$127.58
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	13	13	$1495.00	$209.81
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	11	11	$1203.64	$189.86

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	97	97	$138.00	$100.61
38900 Lymph node imaging during surgery	72	71	$1013.89	$127.83
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	61	61	$187.00	$155.58
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	35	34	$1776.00	$307.90
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	34	34	$950.00	$192.03
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	33	32	$3846.00	$796.39
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	29	26	$740.00	$172.89
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	27	27	$750.00	$80.76
38510 Biopsy or removal of deep lymph nodes of neck	26	26	$1200.00	$250.56
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	25	22	$301.00	$65.27
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	25	25	$1040.00	$193.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	25	25	$66.00	$42.61
99213 Established patient office or other outpatient visit, typically 15 minutes	24	22	$80.00	$70.64
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	21	20	$637.00	$92.34
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	20	20	$867.00	$100.92
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	17	17	$1980.00	$205.30
38500 Biopsy or removal of lymph nodes, open procedure	16	16	$750.00	$133.78
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	14	13	$1495.00	$227.91
11626 Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals	11	11	$1165.00	$138.80
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	11	11	$2329.00	$593.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	143	143	$136.89	$100.02
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	107	105	$3846.00	$818.08
38900 Lymph node imaging during surgery	67	66	$1000.00	$126.26
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	64	57	$1980.00	$204.91
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	61	61	$187.00	$151.93
38510 Biopsy or removal of deep lymph nodes of neck	29	29	$1241.38	$197.64
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	27	26	$1611.56	$211.72
99213 Established patient office or other outpatient visit, typically 15 minutes	24	23	$79.38	$69.37
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	23	$66.00	$42.04
10160 Aspiration of abscess, blood accumulation, blister, or cyst	21	12	$188.00	$102.92
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	21	21	$2329.00	$602.44
11626 Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals	17	16	$1165.00	$137.16
38500 Biopsy or removal of lymph nodes, open procedure	16	15	$750.00	$117.06
15240 Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)	11	11	$2254.00	$680.41
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	11	11	$740.00	$215.50

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	114	113	$138.00	$110.24
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	96	94	$3846.00	$908.13
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	62	53	$1980.00	$227.72
38900 Lymph node imaging during surgery	59	58	$1000.00	$139.06
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	47	47	$187.00	$170.42
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	33	33	$1554.00	$224.49
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	19	$66.00	$45.32
38510 Biopsy or removal of deep lymph nodes of neck	18	18	$1200.00	$225.68
99213 Established patient office or other outpatient visit, typically 15 minutes	15	13	$80.00	$75.74
38500 Biopsy or removal of lymph nodes, open procedure	13	13	$750.00	$128.91
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	11	11	$1040.00	$179.82
99202 New patient office or other outpatient visit, typically 20 minutes	11	11	$104.00	$75.90
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	11	11	$950.00	$252.17
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	11	11	$637.00	$101.40

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	155	155	$138.00	$112.95
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	87	86	$3846.00	$928.35
38900 Lymph node imaging during surgery	63	63	$1000.00	$144.16
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	58	46	$1980.00	$234.36
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	29	29	$187.00	$171.71
38525 Biopsy or removal of lymph nodes of under the arm, open procedure	27	27	$1554.00	$236.03
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	24	24	$637.00	$103.89
38510 Biopsy or removal of deep lymph nodes of neck	23	23	$1200.00	$220.98
99202 New patient office or other outpatient visit, typically 20 minutes	21	21	$104.00	$77.92
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	21	21	$1495.00	$327.77
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	21	21	$740.00	$256.55
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	17	16	$950.00	$276.38
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	17	13	$431.06	$78.89
38500 Biopsy or removal of lymph nodes, open procedure	17	17	$764.71	$132.67
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	17	17	$66.00	$45.48
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	16	16	$1860.00	$703.92
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	16	12	$513.13	$91.06
99213 Established patient office or other outpatient visit, typically 15 minutes	15	15	$80.00	$76.59
15240 Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)	15	14	$2254.00	$735.01
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	14	12	$535.00	$86.70
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	14	14	$2329.00	$655.48
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	14	14	$991.00	$122.26
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	12	12	$867.00	$114.18
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	12	11	$822.00	$105.77
11626 Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals	11	11	$1165.00	$155.64
11606 Removal of cancer skin growth of body, arms, or legs, more than 4.0 cm	11	11	$1040.00	$169.04

Medical Specialties & State Licenses

CMS Verified: 2022-09-01

Plastic Surgery Primary Specialty

NUCC Taxonomy Code: 208200000X

State License IN 01041504A

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Surgery - Plastic and Reconstructive Surgery

NUCC Taxonomy Code: 2086S0122X

State License IN 01041504

A surgeon who specializes in plastic and reconstructive surgery.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

100347810 (IN)

Hospital & Practice Group Affiliations

Community Physician Network Specialty Care Llc

8075 N Shadeland Ave, Indianapolis, IN 462502693

Phone: 3176218000

Community Physicians Of Indiana Inc

8040 Clearvista Pkwy, Indianapolis, IN 462565604

Phone: 3176216470

Secondary Practice Locations

8040 Clearvista Pkwy, Ste 570

Indianapolis, IN 46256

Phone: 3176212520

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Elaine Off , FNP-C

Nurse Practitioner - Family

NPI 1285230268

Family Nurse Practitioner (Certified)

Samantha Jenney , PA-C

Physician Assistant

NPI 1992220719

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

📍

Updated Practice Location August 05, 2022

Registered at 8040 CLEARVISTA PKWY STE 520, INDIANAPOLIS, IN 462565604 (Tel: 3176219470)

📍

Updated Business Mailing Address August 05, 2022

Registered at 6626 E 75TH ST STE 500, INDIANAPOLIS, IN 462502890

👤

Provider Name / Credentials Updated September 14, 2018

Recorded as JEFFREY WAGNER, MD

📍

Updated Practice Location August 13, 2018

Registered at 8040 CLEARVISTA PKWY, STE 570, INDIANAPOLIS, IN 46256 (Tel: 3176212520)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 13, 2018

Surgery (License #01041504 in IN)

✅

NPI Profile Active May 19, 2008

NPI status registered as active in NPPES database

📍

Updated Practice Location May 19, 2008

Registered at 8040 CLEARVISTA PKWY, STE 570, INDIANAPOLIS, IN 462564673 (Tel: 3176212520)

📍

Updated Business Mailing Address May 19, 2008

Registered at 8040 CLEARVISTA PKWY, STE 570, INDIANAPOLIS, IN 462564673 (Tel: 3176212520)

👤

Provider Name / Credentials Updated May 19, 2008

Recorded as JEFFREY WAGNER, MD, PC

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 19, 2008

Plastic Surgery (License #208200000X in IN)

🟢

Initial NPI Registration & Enumeration June 24, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1881690790

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 24, 2005

Last Update: September 01, 2022

Sole Proprietor: No

Update or Correct Profile

Mailing Address

6626 E 75th St Ste 500

Indianapolis, IN 462502890

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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