SOUTHERN INDIANA FAMILY PRACTICE CENTER PC (NPI# 1770626152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770626152 |
| Entity Type | Organization |
| Organization Name | SOUTHERN INDIANA FAMILY PRACTICE CENTER PC |
| Other Organization Name | SOUTHERN INDIANA FAMILY PRACTICE CENTER |
| Practice Address |
3209 W Fullerton Pike Ste A Bloomington IN 47403-4060 |
| Practice Telephone | 8123396744 |
| Practice Fax Number | 8126719113 |
| Mailing Telephone | 8123396744 |
| Mailing Fax Number | 8126719113 |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2015-11-20 |
| Authorized Official Name | KAREN L. REID-RENNER (OWNER) |
| Authorized Official Telephone | 8123396744 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 71002130A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 305R00000X | Preferred Provider Organization | 01055670A | IN | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200367600A | 05 |
| Other Name | Type Code |
|---|---|
| Southern Indiana Family Practice Center | Doing Business As Name - Organization |
| Street Address |
3209 W FULLERTON PIKE STE A |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-4060 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336255900 | William J Schmalz | Internal Medicine | 3209 W Fullerton Pike, Suite E, Bloomington, IN 47403-4060 | 2006-08-23 |
| 1063068567 | Shanna Kay Klun | Registered Nurse | 3209 W Fullerton Pike, Bloomington, IN 47403-4060 | 2019-08-12 |
| 1033468715 | Vein Clinic LLC | Phlebology | 3209 W Fullerton Pike, Suite G, Bloomington, IN 47403-4060 | 2012-09-10 |
| 1033466495 | Varicose Vein Treatment Center | Phlebology | 3209 W Fullerton Pike, Suite C, Bloomington, IN 47403-4060 | 2012-08-04 |
| 1861672529 | Adamson Medical LLC | Family Medicine | 3209 W Fullerton Pike, Bloomington, IN 47403-4057 | 2007-11-11 |
| 1184812745 | Decatur Vein Clinic of Bloomington, Inc. | Surgery | 3209 W Fullerton Pike, Bloomington, IN 47403-4057 | 2007-10-09 |
| 1457570541 | Monroe Family Practice, LLC | Family Medicine | 3209 W Fullerton Pike, Suite B, Bloomington, IN 47403-4057 | 2007-04-25 |
| 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 | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902343346 | Count On Me Senior Care | Preferred Provider Organization | 359 Creekbend Ln, Indianapolis, IN 46217-2720 | 2017-01-24 |
| 1518313642 | David C. Wood, D.d.s., LLC | Preferred Provider Organization | 266 Medical Dr, Carmel, IN 46032-2944 | 2016-05-07 |
| 1679965263 | Life Solutions South of Indiana | Preferred Provider Organization | 120 E Market St, Indianapolis, IN 46204-3250 | 2015-02-19 |
| 1326318486 | Mercho Medical Service Inc | Preferred Provider Organization | 1311 N. Arlington Avenue, Suite 108, Indianapolis, IN 46219-3260 | 2012-01-06 |
| 1457649857 | Divine Chiropractic LLC | Preferred Provider Organization | 404 North John F Kennedy Avenue, Loogootee, IN 47553 | 2011-07-19 |
| 1225262702 | Essential Development Corporation | Preferred Provider Organization | 1426 W 29th St Ste 209, Indianapolis, IN 46208-4993 | 2009-05-12 |
| 1265666382 | Monon Volunteer Fire Dept Inc | Preferred Provider Organization | 103 E Third St, Monon, IN 47959 | 2009-05-04 |
| 1609018522 | Synapse Neutomonitoring Inc | Preferred Provider Organization | 1365 N Manchester Dr, Greenfield, IN 46140-7764 | 2009-03-25 |
| 1891907903 | Journeys Counseling Center, LLC | Preferred Provider Organization | 10182 Ranford Blvd, Fortville, IN 46040-1474 | 2007-05-03 |
| 1285846360 | Midwest Residential Services, Inc. | Preferred Provider Organization | 2425 N. Meridian Street, Suite B, Indianapolis, IN 46208 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
| 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.