THE TRUSTEES OF INDIANA UNIVERSITY (NPI# 1336538917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336538917 |
| Entity Type | Organization |
| Organization Name | THE TRUSTEES OF INDIANA UNIVERSITY |
| Other Organization Name | INDIANA UNIVERSITY SPORTS MEDICINE |
| Practice Address |
1001 E 17th St Assembly Hall Bloomington IN 47408-1590 |
| Mailing Address |
5050 Spring Valley Rd Dallas TX 75244-3995 |
| Practice Telephone | 8122373883 |
| Practice Fax Number | 9723673451 |
| Mailing Telephone | 8005559073 |
| Mailing Fax Number | 9723673452 |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-20 |
| Authorized Official Name | MOUZON BASS III (AGENT) |
| Authorized Official Telephone | 18005559073 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Indiana university sports medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356675540 | The Trustees of Indiana University | Optometrist | 800 E Atwater Ave, Bloomington, IN 47405-3635 | 2009-09-22 |
| Street Address |
1001 E 17TH ST ASSEMBLY HALL |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47408-1590 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659376424 | Andy S. Hipskind | Family Medicine | 1001 E 17th St, Bloomington, IN 47408-1590 | 2005-06-16 |
| 1831757541 | Hannah Nicole Miller | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2019-05-29 |
| 1528525920 | Jacob Steven Laverman | Physical Therapist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2019-02-22 |
| 1730671934 | Lewis Meyer Young | Neuromusculoskeletal Medicine, Sports Medicine | 1001 E 17th St, Bloomington, IN 47408-1590 | 2018-06-04 |
| 1811404171 | Jacob Riley Proffer | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2018-01-08 |
| 1376057083 | Katherine Adair O'donnell | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2017-11-17 |
| 1003341918 | Jonathan Wicks | Psychiatry & Neurology | 1001 E 17th St, Bloomington, IN 47408-1590 | 2017-04-28 |
| 1396277240 | Athletico, Ltd. | Physical Therapist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2017-03-30 |
| 1003354242 | Mitch Taffe | Specialist/Technologist | 1001 E 17th St, Athletic Training, Bloomington, IN 47408-1590 | 2017-02-08 |
| 1992170898 | John Pauer | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2015-12-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669079398 | Ta-kisha Jones | Health Educator | 309 N. Woodlawn Ave, Bloomington, IN 47408 | 2020-10-06 |
| 1265915904 | Meghan Elizabeth Kinkead | Specialist/Technologist | Simon Skjodt Assembly Hall, 1001 East 17th Street, Bloomington, IN 47408 | 2018-09-10 |
| 1316499395 | Marabai Rose Counseling, LLC | Social Worker | 4568 East State Rd 45, Bloomington, IN 47408 | 2016-10-26 |
| 1295133908 | Eden Embree | Specialist/Technologist | 1001 E. 17th Street, Assembly Hall, Bloomington, IN 47408 | 2014-12-11 |
| 1588995229 | Create-a-smile PC | Dentist | 219 E. 17th St., Bloomington, IN 47408 | 2010-01-20 |
| 1609053289 | Laurette Frazier | Counselor | 2815 E. 10th Street, Stone Belt, Bloomington, IN 47408 | 2008-01-26 |
| 1770709917 | Robin A. Roberts | Dentist | 104 E. 19th Street, Bloomington, IN 47408 | 2007-04-17 |
| 1376614008 | David Rudolf Fletcher | General Practice | 126 S. Hampton Ct, Bloomington, IN 47408 | 2006-11-13 |
| 1114013752 | Christole, Inc | Intermediate Care Facility, Mentally Retarded | 2727 N Dunn, Bloomington, IN 47408 | 2006-10-04 |
| 1003850322 | Priti V Jindal | Internal Medicine | 2455 N Tamarack Trl, Bloomington, IN 47408 | 2006-06-16 |
| Find all providers in zip 47408 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073165650 | Genevieve Elon Monge | Family Medicine | 18651 Valley Blvd, Bloomington, CA 92316-1831 | 2019-07-12 |
| 1982117172 | Andry Medical Services | Family Medicine | 451 S Park Ridge Rd Ste 101, Bloomington, IN 47401-8589 | 2017-11-09 |
| 1033459904 | Charles R Farmer | Family Medicine | 3480 S Oak Ridge Dr, Bloomington, IN 47401-8926 | 2013-02-28 |
| 1467798504 | James Anthony Ray | Family Medicine | 2001 E Hillside Dr Lot 4, Bloomington, IN 47401-6692 | 2012-12-18 |
| 1902140585 | Fountain Healthcare Limited Liability Company | Family Medicine | 2412 E Washington St Ste 6, Bloomington, IL 61704-4497 | 2012-11-20 |
| 1306147236 | Community Health Network | Family Medicine | 524 N Fairview St, Bloomington, IN 47404-3774 | 2010-11-09 |
| 1942501978 | Premier Medical Group, LLC | Family Medicine | 2102 E Washington St, Bloomington, IL 61701-4321 | 2010-11-08 |
| 1356660666 | Glen Edward Tomlinson | Family Medicine | 42 Crista Ann Ct, Bloomington, IL 61704-8699 | 2010-05-26 |
| 1285862664 | Charles W Mcclary | Family Medicine | 1411 S Sare Rd, Bloomington, IN 47401-4431 | 2009-06-24 |
| 1982840005 | Thomas Patterson Cairns | Family Medicine | 10258 Berkshire Rd, Bloomington, MN 55437-2265 | 2008-12-18 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47408 |
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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.