Provider Demographics
NPI:1629047196
Name:JONES, THOMAS I (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:I
Last Name:JONES
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 N 26TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2842
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7599
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030374A207R00000X, 207RH0000X, 207RX0202X
ORMD205532207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100387490Medicaid
IN000000196837OtherANTHEM PROVIDER NUMBER
IN9397186OtherPHCS PID NUMBER
IN000000196837OtherANTHEM PIN # / ARNETT
IN000000491794OtherANTHEM PIN # / OIGL
IN10825335OtherCAQH NUMBER
IN000000491794OtherANTHEM PIN # / OIGL
IN9397186OtherPHCS PID NUMBER
IN100387490Medicaid
IN830004810Medicare PIN
IN815540MMedicare PIN
IN815500H1Medicare PIN