Organization Active NPI

St Vincent Pediatric Subspecialties

Pediatrics Physician
Indianapolis, IN

National Provider Identifier

1013967736

Registry record updated Nov 17, 2014

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Indianapolis, IN
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Pediatrics PhysicianTaxonomy code 208000000X
License: 050050751 Issued in IN
Legal business name: ST VINCENT PEDIATRIC SUBSPECIALTIES
Practice address: 2001 W 86TH St
Indianapolis, IN 46260-1902
Phone: (317) 338-2273
NPI assigned: May 11, 2006
Last updated: Nov 17, 2014By the provider in NPPES
Organization subpart: Yes
Parent organization: ST VINCENT HOSPITAL AND HEALTH CARE CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2014

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

Authorized official

Name: Kevin McAndrews
Title: Vice President
Phone: (317) 583-3194

Specialties & licenses 15

Specialty (taxonomy)	Code	License	State	Primary
Nurse Practitioner	363L00000X
Orthodontics and Dentofacial Orthopedics Dentistry	1223X0400X
Maternal & Fetal Medicine Physician	207VM0101X
Pediatric Otolaryngology Physician	207YP0228X
Pediatrics Physician	208000000X	050050751	IN	Primary
Pediatric Adolescent Medicine Physician	2080A0000X
Neonatal-Perinatal Medicine Physician	2080N0001X
Pediatric Cardiology Physician	2080P0202X
Pediatric Endocrinology Physician	2080P0205X
Pediatric Hematology & Oncology Physician	2080P0207X
Pediatric Pulmonology Physician	2080P0214X
Physical Medicine & Rehabilitation Physician	208100000X
Pediatric Surgery Physician	2086S0120X
Hospitalist Physician	208M00000X
Pediatric Orthopaedic Surgery Physician	207XP3100X

Addresses

Primary practice location

2001 W 86TH St
Indianapolis, IN 46260-1902

Mailing address

10330 N Meridian St
Suite 201
Indianapolis, IN 46290-1024

Other identifiers 31

Identifier	Type	State
200505130K	Medicaid	IN
200505130L	Medicaid	IN
200505130S	Medicaid	IN
200505130Z	Medicaid	IN
200901000C	Medicaid	IN
200505130D	Medicaid	IN
200505130G	Medicaid	IN
200505130J	Medicaid	IN
200505130N	Medicaid	IN
200505130R	Medicaid	IN
200505130V	Medicaid	IN
200505130Y	Medicaid	IN
200901000B	Medicaid	IN
2602026	Medicaid	OH
200505130B	Medicaid	IN
200505130F	Medicaid	IN
200505130H	Medicaid	IN
200901000A	Medicaid	IN
200505130E	Medicaid	IN
200505130M	Medicaid	IN
200505130T	Medicaid	IN
200505130W	Medicaid	IN
200505130X	Medicaid	IN
2645178	Medicaid	OH
200505130A	Medicaid	IN
200505130C	Medicaid	IN
200505130O	Medicaid	IN
200505130P	Medicaid	IN
200505130U	Medicaid	IN
200505130Q	Medicaid	IN
200505130I	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
O20050214000627	IN	Part B Supplier - Clinic/Group Practice	1557313939	Receives reassigned benefits from 305 practitioners 1 other NPI on this enrollment Practice locations: Indianapolis, IN; Carmel, IN; Kokomo, IN; Lafayette, IN; Lebanon, IN; Washington, IN; Zionsville, IN; Avon, IN…

Other NPIs on the same Medicare enrollment 1

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

St Vincent Pediatric Subspecialties
- Pediatric Critical Care Medicine Physician
- Evansville, IN
- NPI 1851950224
O20050214000627
Same enrollment

National Provider Directory

Part of: St Vincent Stress Center

Locations

2530 Reliable Pkwy
Chicago, IL 60686

7782 Solution Ctr
Chicago, IL 60677

11725 Illinois St
Ste 335
Carmel, IN 46032

301 E Carmel Dr
Ste H400
Carmel, IN 46032
Phone (317) 569-1650

11201 USA Pkwy
Ste 355
Fishers, IN 46037

13861 Olio Rd
#105
Fishers, IN 46037

1717 W 86th St
Indianapolis, IN 46260

8081 Township Line Rd
#23
Indianapolis, IN 46260

8091 Township Line Rd
Indianapolis, IN 46260
Phone (317) 802-9912

8402 Harcourt Rd
Ste 730A
Indianapolis, IN 46260
Phone (317) 338-8943

301 Henry St
Ste B
North Vernon, IN 47265

2200 E Parrish Ave
#101
Owensboro, KY 42303
Phone (270) 683-3232

Practitioners & affiliated clinicians

Practitioners 369

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.

Lynn Alkhatib
- Pediatrics Physician
- Indianapolis, IN
- NPI 1609404441
Medicare reassignment Care Compare group NPD
Kelly Joann Barton, MD
- Pediatrics Physician
- Indianapolis, IN
- NPI 1851950729
Medicare reassignment Care Compare group NPD
Margaret Burke, FNP-C
- Pediatric Nurse Practitioner
- Indianapolis, IN
- NPI 1144049545
Medicare reassignment Care Compare group NPD
Loraine Ruth Condrey, APRN
- Pediatric Nurse Practitioner
- Indianapolis, IN
- NPI 1043622533
Medicare reassignment Care Compare group NPD
Rachel Kochert Dunn, MD
- Pediatric Gastroenterology Physician
- Indianapolis, IN
- NPI 1649569419
Pediatrics
Medicare reassignment Care Compare group NPD
Monica Vermani Durr, APRN
- Pediatric Nurse Practitioner
- Indianapolis, IN
- NPI 1538667076
Medicare reassignment Care Compare group NPD
Luis Fernando Escobar, MD
- Clinical Genetics (M.D.) Physician
- Indianapolis, IN
- NPI 1053396135
Pediatrics
Medicare reassignment Care Compare group NPD
Jessica F Goodman, MD
- Pediatric Hematology & Oncology Physician
- Indianapolis, IN
- NPI 1831112093
Pediatric Hematology-Oncology
Medicare reassignment Care Compare group NPD
Jessica Nell Green, MD
- Pediatric Neurodevelopmental Disabilities Physician
- Indianapolis, IN
- NPI 1578604773
Pediatrics
Medicare reassignment Care Compare group NPD
Brooke Katherine Greene, MD
- Pediatrics Physician
- Indianapolis, IN
- NPI 1013593680
Medicare reassignment Care Compare group NPD
Ronda Alazan Hamaker, MD
- Pediatric Otolaryngology Physician
- Indianapolis, IN
- NPI 1174572184
Medicare reassignment Care Compare group NPD
Jill McCaulley, M.D.
- Maternal & Fetal Medicine Physician
- Indianapolis, IN
- NPI 1669607388
Medicare reassignment Care Compare group NPD

View all 369

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416182400000",
    "number": "1013967736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 N MERIDIAN ST",
            "address_2": "SUITE 201",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
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            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601902",
            "telephone_number": "317-338-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT PEDIATRIC SUBSPECIALTIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST VINCENT HOSPITAL AND HEALTH CARE CENTER INC",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-11-17",
        "status": "A",
        "authorized_official_last_name": "MCANDREWS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "317-583-3194"
    },
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        {
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        {
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            "code": "2080P0202X",
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            "primary": false
        },
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            "code": "2080P0205X",
            "taxonomy_group": "",
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            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
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            "license": null,
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        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
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    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; 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.