JERRY D HEADDY JR. (NPI# 1689679664) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689679664 |
| Entity Type | Individual |
| Full Name | JERRY D HEADDY JR. |
| Credential | MD |
| Practice Address |
550 S Landmark Ave Bloomington IN 47403-3239 |
| Practice Telephone | 8123553299 |
| Practice Fax Number | 8123553290 |
| Mailing Telephone | 8123553299 |
| Mailing Fax Number | 8123553290 |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-08-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01039529A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100185080 | 05 |
| Street Address |
550 S LANDMARK AVE |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-3239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760487623 | Jean A. Creek | Internal Medicine | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2005-06-16 |
| 1225657877 | Valerie Mccullough | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2020-04-14 |
| 1104454768 | Haley C Richardson | Physician Assistant | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2020-03-30 |
| 1669003489 | Keira Bex | Registered Nurse | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2020-01-30 |
| 1992341770 | Melisse Nicole Ferree Gladwell | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2019-11-27 |
| 1841845658 | Rachael M Hamelink | Registered Nurse | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2019-08-08 |
| 1023592300 | Danielle Lee Rogers | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2018-09-21 |
| 1508382003 | Hilary Anderson | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2017-08-16 |
| 1205364494 | Hena Naz Shah | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2017-06-01 |
| 1164957338 | Amanda Butcher | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403 | 2017-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| 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 | 47403 |
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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.