NPIMap

Organization Active NPI

Monticello Emergency Care, LLC

  • Emergency Medicine Physician
  • Bloomington, IN
National Provider Identifier
1003849399
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MONTICELLO EMERGENCY CARE, LLC
Practice address
4011 S Monroe Medical Park Blvd
Bloomington, IN 47403-8000
Phone
(812) 825-1111
NPI assigned
Jul 9, 2006
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Erika O'Brien, M.D.
Title
Ceo
Phone
(765) 446-0170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

4011 S Monroe Medical Park Blvd
Bloomington, IN 47403-8000

Mailing address

3500 State Road 38 E Ste 300
Lafayette, IN 47905-5167
Phone (765) 446-0170

Other identifiers 2

IdentifierTypeStateIssuer
300065600MedicaidIN
DD5512OtherINRAIL ROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050511000403 IN Part B Supplier - Clinic/Group Practice 4183664956 Receives reassigned benefits from 17 practitioners
Practice locations: Bloomington, IN; Winamac, IN

National Provider Directory

National Provider Directory

Locations

7231 Solutions Ctr
Chicago, IL 60677

3500 State Road 38 E
Ste 300
Lafayette, IN 47905
Phone (219) 386-0000

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1003849399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 STATE ROAD 38 E STE 300",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479055167",
            "telephone_number": "765-446-0170",
            "fax_number": "855-506-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 S MONROE MEDICAL PARK BLVD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474038000",
            "telephone_number": "812-825-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO EMERGENCY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "ERIKA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-446-0170",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300065600",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DD5512",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.