GRAND OLD DOCS OF THE SOUTHSIDE (NPI# 1790886844) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790886844 |
| Entity Type | Organization |
| Organization Name | GRAND OLD DOCS OF THE SOUTHSIDE |
| Other Organization Name | CENTRAL INDIANA MEDICAL GROUP |
| Practice Address |
360 S Madison Ave #200 Greenwood IN 46142-3150 |
| Mailing Address |
1350 E County Line Rd Suite I Indianapolis IN 46227-0873 |
| Practice Telephone | 3178659090 |
| Practice Fax Number | 3178650523 |
| Mailing Telephone | 3178659090 |
| Mailing Fax Number | 3178650523 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-06-30 |
| Authorized Official Name | BRENDA R RUSSELL (PHYSICIAN) |
| Authorized Official Telephone | 3178659090 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | DME | 5457630003 | 01 |
| IN | GROUP RR MEDICARE NUMBER | CI4722 | 01 |
| Other Name | Type Code |
|---|---|
| Central Indiana Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942396890 | Grand Old Docs of The Southside | Family Medicine | 134 N Emerson Ave, Greenwood, IN 46143-9760 | 2006-10-05 |
| 1720277544 | Grand Old Docs of The Southside | Family Medicine | 8920 Southpointe Dr, Suite E-1, Indianapolis, IN 46227-7509 | 2007-10-17 |
| Street Address |
360 S MADISON AVE #200 |
| City | GREENWOOD |
| State | IN |
| Zip Code | 46142-3150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952357667 | Brenda P Viegas | Pediatrics | 360 S Madison Ave, # 210, Greenwood, IN 46142-3150 | 2006-05-25 |
| 1063771962 | Carla S Payne | Registered Nurse | 360 S Madison Ave, Suite 100, Greenwood, IN 46142-3117 | 2012-05-11 |
| 1619261336 | Greenwood Physicians Associates LLP | Family Medicine | 360 S Madison Ave, Suite 100, Greenwood, IN 46142-3117 | 2011-05-31 |
| 1871618082 | Rehabilitation Options of Indiana | Marriage & Family Therapist | 360 S Madison Ave, 205, Greenwood, IN 46142-3150 | 2007-03-20 |
| 1457377749 | Community Hospitals of Indiana Inc | Family Medicine | 360 S Madison Ave, Suite 100, Greenwood, IN 46142-3117 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093330979 | Renee Francine Jones | Nurse Practitioner | 698 Oldfield Commons Dr, Greenwood, IN 46142 | 2020-06-16 |
| 1164046876 | Top Dental Care LLC | Dentist | 41 N. Madison Ave, Greenwood, IN 46142 | 2020-05-29 |
| 1467956201 | Gerth Counseling | Social Worker | 386 Meridian Parke Lane, Suit B, Greenwood, IN 46142 | 2018-03-19 |
| 1588019988 | Jessica Lynn Osborne | Speech-Language Pathologist | 1701 Library Park Blvd, Greenwood, IN 46142 | 2016-05-04 |
| 1417301359 | John Thomas Ferguson Jr. | Marriage & Family Therapist | 3209 W Smith Valley Road, #225, Indianapolis, IN 46142 | 2016-04-18 |
| 1982065132 | Linda Barnes | Occupational Therapist | 124 Hawthorne Lane, Greenwood, IN 46142 | 2016-03-16 |
| 1346611688 | Elisha Cain | Optometrist | 1298 Us-31, Greenwood, IN 46142 | 2015-10-13 |
| 1801158456 | Frank William Fortuna | Family Medicine | 461 Camby Court, Greenwood, IN 46142 | 2012-06-11 |
| 1164708202 | Greenwood Family Chiropractic, LLC | Chiropractor | 520 N Sr 135, Suite R, Greenwood, IN 46142 | 2011-11-02 |
| 1447536586 | Leanne Nicole Schlueter | Chiropractor | 520 North Sr 135, Suite R, Greenwood, IN 46142 | 2011-11-02 |
| Find all providers in zip 46142 | ||||
| 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 |
|---|---|---|---|---|
| 1245862473 | Kristina Mckissick | Family Medicine | 805 Montague Ave, Greenwood, SC 29649-1471 | 2020-02-05 |
| 1487212130 | Self Medical Group | Family Medicine | 105 Vinecrest Ct # 510, Greenwood, SC 29646-8031 | 2019-05-29 |
| 1750800264 | Self Medical Group | Family Medicine | 110 Highway 246 N, Greenwood, SC 29649-8748 | 2017-09-15 |
| 1689066060 | Richard Glen Huber | Family Medicine | 31 N Restin Rd, Greenwood, IN 46142-8583 | 2015-02-23 |
| 1679912406 | Michael J. Mooney | Family Medicine | 965 Emerson Pkwy Ste J, Greenwood, IN 46143 | 2013-06-14 |
| 1114362639 | Sarah Ann Beeson | Family Medicine | 1000 Us Highway 31 S, Greenwood, IN 46143-2407 | 2013-05-10 |
| 1013350198 | Elise Rose Laroche | Family Medicine | 747 E County Line Rd Ste D, Greenwood, IN 46143-1082 | 2013-04-09 |
| 1548506868 | Community Health Network Inc | Family Medicine | 615 W Smith Valley Rd, Greenwood, IN 46142-3048 | 2012-12-13 |
| 1801158456 | Frank William Fortuna | Family Medicine | 461 Camby Court, Greenwood, IN 46142 | 2012-06-11 |
| 1417252636 | Self Medical Group | Family Medicine | 138 Wells Avenue, Greenwood, SC 29646-3837 | 2011-01-19 |
| Find all providers in GREENWOOD | ||||
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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.