Indiana University Health Southern Indiana Physicians LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS LLC

Practice address

7 E Main St
Gosport, IN 47433-7034

Phone

(812) 879-4222

Fax

(812) 879-4834

NPI assigned

May 28, 2008

Organization subpart

Yes

Parent organization

INDIANA UNIVERSITY HEALTH BLOOMINGTON INCAs reported in NPPES

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

Authorized official

Name

Mr. Marlon B Fishel

Title

Administration, Iu Health Sip

Phone

(812) 353-5866

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Gosport Family Practice Other name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Indiana University Health Southern Indiana Physicians, Inc

  • Rural Health Clinic/Center
  • Spencer, IN
  • NPI 1366600231

  O20040423000556

  Same enrollment
• Indiana University Health Southern Indiana Physicians, LLC

  • Multi-Specialty Clinic/Center
  • Bloomington, IN
  • NPI 1013953983

  O20040423000556

  Same enrollment

Part of

Bloomington Hospital Ca

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1003074972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474021329",
            "telephone_number": "812-879-4222",
            "fax_number": "812-879-4834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 E MAIN ST",
            "city": "GOSPORT",
            "state": "IN",
            "postal_code": "474337034",
            "telephone_number": "812-879-4222",
            "fax_number": "812-879-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIANA UNIVERSITY HEALTH BLOOMINGTON INC",
        "enumeration_date": "2008-05-28",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "FISHEL",
        "authorized_official_first_name": "MARLON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATION, IU HEALTH SIP",
        "authorized_official_telephone_number": "812-353-5866",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200874400A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI4187",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gosport Family Practice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Gosport Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Gosport Dental Clinic PC
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• Alexis Heck-Briton, DDS
• Paula Dorland Jarrard, OTD, OTR/L
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• Barbara A. Lamere-Heck, DDS
• Meredith Lulich, MD
• Sarah E Parker, FNP-BC

• Rural Health Clinic/Center in Gosport, IN
• Providers in Gosport, IN by specialty
• Rural Health Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.