NPIMap

Organization Active NPI

Allied Physicians of Michiana, LLC

  • Orthopaedic Surgery Physician
  • South Bend, IN
National Provider Identifier
1023343282
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ALLIED PHYSICIANS OF MICHIANA, LLC
Practice address
6301 University Commons
Suite 100
South Bend, IN 46635-1571
Phone
(574) 247-4667
Fax
(574) 271-4458
NPI assigned
Oct 6, 2009
Organization subpart
Yes
Parent organization
ALLIED PHYSICIANS OF MICHIANA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Authorized official

Name
Shery A Roussarie
Title
Ceo
Phone
(574) 251-2100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

6301 University Commons
Suite 100
South Bend, IN 46635-1571

Mailing address

6301 University Commons
Suite 230
South Bend, IN 46635-1571
Phone (574) 251-2100

Other identifiers 3

IdentifierTypeStateIssuer
200962980JMedicaidIN
200962980ZMedicaidIN
201236170MedicaidIN

Other names 1

  • Allied Bone and joint Doing business as

National Provider Directory

National Provider Directory
Part of
Allied Physicians of Michiana LLC

NPI Registry JSON

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

{
    "created_epoch": "1254787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485475200000",
    "number": "1023343282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS",
            "address_2": "SUITE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351571",
            "telephone_number": "574-251-2100",
            "fax_number": "574-251-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS",
            "address_2": "SUITE 100",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351571",
            "telephone_number": "574-247-4667",
            "fax_number": "574-271-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIED PHYSICIANS OF MICHIANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIED PHYSICIANS OF MICHIANA, LLC",
        "enumeration_date": "2009-10-06",
        "last_updated": "2017-01-27",
        "status": "A",
        "authorized_official_last_name": "ROUSSARIE",
        "authorized_official_first_name": "SHERY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "574-251-2100"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200962980J",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200962980Z",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201236170",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allied Bone and joint",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.