NPIMap

Organization Active NPI

Allied Physicians of Michiana

  • Obstetrics & Gynecology Physician
  • South Bend, IN
National Provider Identifier
1003048125
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ALLIED PHYSICIANS OF MICHIANA
Practice address
6301 University Commons
Suite 230
South Bend, IN 46635-1571
Phone
(574) 251-2100
Fax
(574) 251-2150
NPI assigned
Aug 24, 2009
Last updated
Jul 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shery A Roussarie
Title
Ceo
Phone
(574) 251-2100

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X Primary
Orthopaedic Surgery Physician 207X00000X
Otolaryngology Physician 207Y00000X
Surgery Physician 208600000X
Vascular Surgery Physician 2086S0129X
Urology Physician 208800000X
Colon & Rectal Surgery Physician 208C00000X

Addresses

Primary practice location

6301 University Commons
Suite 230
South Bend, IN 46635-1571

Mailing address

6301 University Commons
Suite 230
South Bend, IN 46635-1571
Phone (574) 251-2100

Other identifiers 1

IdentifierTypeStateIssuer
200962980MedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Allied Physicians of Michiana LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1003048125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS",
            "address_2": "SUITE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351571",
            "telephone_number": "574-251-2100",
            "fax_number": "574-251-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS",
            "address_2": "SUITE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351571",
            "telephone_number": "574-251-2100",
            "fax_number": "574-251-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIED PHYSICIANS OF MICHIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "ROUSSARIE",
        "authorized_official_first_name": "SHERY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "574-251-2100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200962980",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.