Active NPI
Southern Indiana ENT, LLC
- Otolaryngology Physician
- Columbus, IN
National Provider Identifier
1013030618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- Legal business name
- SOUTHERN INDIANA ENT, LLC
- Practice address
- 1655 N Gladstone Ave
Suite E
Columbus, IN 47201-5392 - Phone
- (812) 376-3071
- Fax
- (812) 378-5721
- NPI assigned
- Apr 9, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Anthony D Sanders, M.D.
- Title
- Co-Owner-Partner
- Phone
- (812) 376-3071
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | Primary |
Addresses
Primary practice location
1655 N Gladstone Ave
Suite E
Columbus, IN 47201-5392
Mailing address
1655 N Gladstone Ave
Suite E
Columbus, IN 47201-5392
Phone (812) 376-3071
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200337430 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070606000064 | IN | Part B Supplier - Clinic/Group Practice | 6507964137 |
Receives reassigned benefits from 22 practitioners Practice locations: Columbus, IN; Franklin, IN; Greenwood, IN; Seymour, IN |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2172504 | Southern Indiana ENT | Certificate of waiver | Sep 23, 2027 |
National Provider Directory
National Provider DirectoryLocations
1655 N Gladstone Ave
Columbus, IN 47201
Phone (812) 372-2245
Interoperability endpoints
- https://api.platform.athenahealth.com/12832/brand/1/csg/1/fhir/r4
Practitioners 25
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1391385600000",
"number": "1013030618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1655 N GLADSTONE AVE",
"address_2": "SUITE E",
"city": "COLUMBUS",
"state": "IN",
"postal_code": "472015392",
"telephone_number": "812-376-3071",
"fax_number": "812-378-5721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1655 N GLADSTONE AVE",
"address_2": "SUITE E",
"city": "COLUMBUS",
"state": "IN",
"postal_code": "472015392",
"telephone_number": "812-376-3071",
"fax_number": "812-378-5721"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN INDIANA ENT, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-09",
"last_updated": "2014-02-03",
"status": "A",
"authorized_official_last_name": "SANDERS",
"authorized_official_first_name": "ANTHONY",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CO-OWNER-PARTNER",
"authorized_official_telephone_number": "812-376-3071",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200337430",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, IN
- South Central Endodontics
- South Central Indiana Pathology, PC
- Southeastern Indiana Anesthesia Associates PC
- Southeastern Indiana Gastroenterology
- Southern Indiana Aesthetic and Plastic Surgery LLC
- Southern Indiana Integrative Therapy Services
- Southern Indiana Nephrology and Hypertension Inc
- Southern Indiana Orthopedics
- Southern Indiana Orthopedics Inc
- Southern Indiana Surgery Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.