Individual provider Active NPI

Maxwell Verbrugge, MD

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1003592148
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1120 W. Michigan St.
Gatch Hall Suite 630
Indianapolis, IN 46202
Phone
(317) 278-2694
NPI assigned
Jun 23, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X IN Primary

Addresses

Primary practice location

1120 W. Michigan St.
Gatch Hall Suite 630
Indianapolis, IN 46202

Mailing address

3368 4 Mile CT NE
Ada, MI 49301-8148
Phone (616) 558-3061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250625001511 IN Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 7517479595

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1003592148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3368 4 MILE CT NE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493018148",
            "telephone_number": "616-558-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W. MICHIGAN ST.",
            "address_2": "GATCH HALL SUITE 630",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202",
            "telephone_number": "317-278-2694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERBRUGGE",
        "first_name": "MAXWELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-23",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.