Provider Demographics
NPI:1467411231
Name:SUTTON, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:SUTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:915 MEZZANINE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8637
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-838-6350
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037260A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100232550Medicaid
INSU15694039Medicaid
IN000000197899OtherANTHEM PROVIDER NUMBER
IN10826030OtherCAQH NUMBER
IN9397536OtherPHCS PID PROVIDER
IN100232550Medicaid
IN390005514Medicare PIN
IN142080JMedicare PIN
IN176680BMedicare PIN
INC91142Medicare UPIN
INSU15694039Medicaid
IN815500G6Medicare PIN