Basic Information
Provider Information | |||||||||
NPI: | 1841269180 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REGNIER | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | PENNINGTON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1200 W WHITE RIVER BLVD | ||||||||
Address2: |   | ||||||||
City: | MUNCIE | ||||||||
State: | IN | ||||||||
PostalCode: | 473034988 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8776685621 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 550 S HOKE AVE | ||||||||
Address2: |   | ||||||||
City: | FRANKFORT | ||||||||
State: | IN | ||||||||
PostalCode: | 460412664 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7654488000 | ||||||||
FaxNumber: | 7656592577 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/17/2006 | ||||||||
LastUpdateDate: | 03/05/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/05/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01045380A | IN | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207Q00000X | 01045380A | IN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 9397381 | 01 | IN | PHCS PID NUMBER | OTHER | 10825814 | 01 | IN | CAQH NUMBER | OTHER | 200131040 | 05 | IN |   | MEDICAID | 000000315113 | 01 | IN | ANTHEM FP PROVIDER NUMBER | OTHER | 000000393549 | 01 | IN | ANTHEM UC PROVIDER NUMBER | OTHER |