PEDIATRIC SURGICAL ASSOCIATES INC (NPI# 1790880292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790880292 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC SURGICAL ASSOCIATES INC |
| Practice Address |
250 N Shadeland Ave Ste 200 Indianapolis IN 46219-4959 |
| Mailing Address |
705 Riley Hospital Dr Ste 2500 Indianapolis IN 46202-5109 |
| Practice Telephone | 8776685621 |
| Mailing Telephone | 3172744681 |
| Mailing Fax Number | 3172744491 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-09-30 |
| Authorized Official Name | JUDITH COLEMAN (CFO) |
| Authorized Official Telephone | 3179483525 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200349840 | 05 |
| Street Address |
250 N SHADELAND AVE STE 200 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46219-4959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649652173 | Tyler E Owens | Clinical Neuropsychologist | 250 N Shadeland Ave Ste 200, Indianapolis, IN 46219-4959 | 2015-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518571157 | Kara Kathryn Berning | Dietitian, Registered | 2040 N. Shadeland Ave, Suite 130, Indianapolis, IN 46219 | 2020-09-01 |
| 1780223750 | Erin Cannon | Specialist | 1543 N Post Rd, Indianapolis, IN 46219 | 2019-12-23 |
| 1073151239 | Tanicka Elizabeth Word | Behavior Technician | 6635 E 21st Street, West Building, Indianapolis, IN 46219 | 2019-12-18 |
| 1790322527 | Arlington Westend Dental LLC | Dentist | 5900 E 10th St, Indianapolis, IN 46219 | 2019-11-27 |
| 1336645985 | Lynell Westbrook Gates | Counselor | 1311 N Arlington Ave Ste 102, Indianapolis, IN 46219 | 2018-04-03 |
| 1861991689 | Comfort Dental LLC | Clinic/Center | 8151 E 21st St., Indianapolis, Indianapolis, IN 46219 | 2018-02-07 |
| 1467811570 | Fresenius Medical Care Indiana, LLC | Clinic/Center | 6701 E 21st St, Indianapolis, IN 46219 | 2016-02-17 |
| 1992197289 | Casey Baker | Physician Assistant | 1500 N Ritter Ave (medical Associates, LLP), Indianapolis, IN 46219 | 2015-02-24 |
| 1811398407 | Adam Romesser | Pharmacist | 8907 E. 10th St., Indianapolis, IN 46219 | 2014-09-15 |
| 1225448673 | Justin Stauffer | Pharmacist | 5903 E Pleasant Run Parkway North Dr, Indianapolis, IN 46219 | 2014-05-06 |
| Find all providers in zip 46219 | ||||
| Taxonomy Code | 2086S0120X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Pediatric Surgery |
| A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194081760 | Britney Lynne Grayson | Surgery | 8040 Clearvista Pkwy Ste 460, Indianapolis, IN 46256-4673 | 2012-04-07 |
| 1962592469 | Evan R. Kokoska | Surgery | 2001 W. 86th Street, Pediatric Hospital, Indianapolis, IN 46260 | 2006-10-13 |
| 1902833395 | Sunghoon Kim | Surgery | 8040 Clearvista Pkwy Ste 340, Indianapolis, IN 46256-4673 | 2006-06-28 |
| 1225464324 | Halkawt Ali Nuri | Surgery | 545 Barnhill Dr, Suite 215, Indianapolis, IN 46202-5112 | 2013-09-20 |
| 1184881641 | Jeremy Herrmann | Surgery | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2008-05-21 |
| 1548317431 | Matthew Landman | Surgery | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2007-01-04 |
| 1811066608 | Robert C Burns | Surgery | 705 Riley Hospital Dr, Ste 2500, Indianapolis, IN 46202-5109 | 2006-11-07 |
| 1699855304 | John W Brown | Surgery | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2006-10-17 |
| 1841393311 | Mark Rodefeld | Surgery | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2006-09-07 |
| 1952416356 | Mark Turrentine | Surgery | 705 Riley Hospital Dr, Indianapolis, IN 46202 | 2006-08-19 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46219 |
Please comment or provide details below to improve the information on PEDIATRIC SURGICAL ASSOCIATES INC.
| 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.