MR. JARED L BROCK (NPI# 1073551248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073551248 |
| Entity Type | Individual |
| Full Name | MR. JARED L BROCK |
| Credential | PA |
| Practice Address |
4001 W Goeller Blvd Ste A Columbus IN 47201-8309 |
| Mailing Address |
Po Box 775383 Chicago IL 60677-5383 |
| Practice Telephone | 8123753330 |
| Practice Fax Number | 8123753329 |
| Mailing Telephone | 8123753000 |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-10-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10000575A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | INDIANA LICENSE | 10000575A | 01 |
| IN | ANTHEM PIN | 000000991456 | 01 |
| Street Address |
4001 W GOELLER BLVD STE A |
| City | COLUMBUS |
| State | IN |
| Zip Code | 47201-8309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962460964 | Andrea Mernitz | Family Medicine | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2006-05-02 |
| 1639652100 | Svetlana Varchenko | Nurse Practitioner | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2018-09-11 |
| 1174001291 | Abra Black | Nurse Practitioner | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2018-07-31 |
| 1760935134 | Danielle Keach | Nurse Practitioner | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2016-08-02 |
| 1124040589 | Brian J Niedbalski | Family Medicine | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2006-07-24 |
| 1336172394 | Philippa M.e Shedd | Family Medicine | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2006-07-09 |
| 1285692921 | Ann Elizabeth James | Nurse Practitioner | 4001 W Goeller Blvd Ste A, Columbus, IN 47201-8309 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699389569 | Ryanne Nicole Slavens | Speech-Language Pathologist | 1974 Glenmoor Drive, Columbus, IN 47201 | 2020-09-08 |
| 1023670759 | Alisha Nicole Scoville | Counselor | 2630 22nd Street, Columbus, IN 47201 | 2019-07-02 |
| 1467964718 | Columbus Radiology Physicians LLC | Radiology | 2400 E. 17th Street, Columbus, IN 47201 | 2017-10-26 |
| 1790148849 | Gabriel Woon | Specialist | 913 25th St., Columbus, IN 47201 | 2016-04-05 |
| 1144680604 | Forefront Dermatology, S.c. | Dermatology | 244 Westwood Blvd, Columbus, IN 47201 | 2016-02-26 |
| 1871832550 | Jennifer Lynn Grant | Nurse Practitioner | 836 Jackson St., Columbus, IN 47201 | 2013-01-31 |
| 1235404526 | Eric Philip Tannenbaum | Orthopaedic Surgery | 940 N Marr Rd Ste C, Columbus, IN 47201 | 2012-03-20 |
| 1881994176 | Terri Ann Brewer | Social Worker | 12000 W. Moores Vineyard Rd, Columbus, IN 47201 | 2010-11-02 |
| 1255654620 | The Kane Group LLC | Durable Medical Equipment & Medical Supplies | 927 Fourth Street, Columbus, IN 47201 | 2010-03-12 |
| 1023243771 | Allison K Royer | Otolaryngology | 2326 18th Street, Suite 230, Columbus, IN 47201 | 2009-05-26 |
| Find all providers in zip 47201 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356941603 | Ingrid Mompoint-butler | Physician Assistant | 1911 Oakland Park Ave, Columbus, OH 43224-3630 | 2020-10-27 |
| 1649886557 | Justin Knox | Physician Assistant | 7416 Roslindale Dr, Columbus, OH 43235-8904 | 2020-09-17 |
| 1336766310 | Mckenna Marie Wilson | Physician Assistant | 4752 Bentham Dr, Columbus, OH 43220-3204 | 2020-06-25 |
| 1881226744 | Adrian Gorzitze-maxey | Physician Assistant | 117 W Como Ave, Columbus, OH 43202-1027 | 2020-02-09 |
| 1699316604 | James Rodeman | Physician Assistant | 1351 Wyandotte Rd, Columbus, OH 43212-3248 | 2019-10-01 |
| 1740830017 | Rylie Taylor Ingham | Physician Assistant | 285 E State St Ste 600, Columbus, OH 43215-4329 | 2019-09-18 |
| 1487201976 | Columbus Surgical Assist, LLC | Physician Assistant | 605 N. High Street #234, Columbus, OH 43215-2024 | 2019-08-20 |
| 1699237743 | Stefan Khensouri | Physician Assistant | 3375 Paddington Dr, Columbus, IN 47203-4328 | 2019-04-05 |
| 1932681715 | Michael Kenneth Johnson | Physician Assistant | 5399 Coachman Rd Apt E, Columbus, OH 43220-6270 | 2018-08-29 |
| 1760972426 | Simon Nke Acha | Physician Assistant | 285 E State St Ste 360, Columbus, OH 43215-4357 | 2018-05-17 |
| Find all providers in COLUMBUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.