Provider Demographics
NPI:1447453832
Name:MEDLER, JASON P (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:MEDLER
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 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-747-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085526207P00000X
IN01064825A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000569895OtherANTHEM BC/BS
IN200902570Medicaid
INP00742245OtherRAILROAD MEDICARE
IN000000741695OtherANTHEM BCBS
INP00711994OtherRAILROAD MEDICARE
IN000000627041OtherANTHEM BC/BS
INP00841063OtherRAILROAD MEDICARE
IN000000627041OtherANTHEM BC/BS
IN000000741695OtherANTHEM BCBS
IN261920IMedicare PIN
IN000000569895OtherANTHEM BC/BS
IN265520MMedicare PIN