Grand Ole Docs of the Southside, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GRAND OLE DOCS OF THE SOUTHSIDE, LLC

Doing business as

Central Indiana Medical Group

Practice address

8686 Madison Ave
Suite F
Indianapolis, IN 46227-7207

Phone

(317) 884-3725

Fax

(317) 881-0933

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Andrew A Johnstone, MD

Title

Physician

Phone

(317) 884-3725

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Central Indiana Medical Group Doing business as

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1033205984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E COUNTY LINE RD",
            "address_2": "SUITE H",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462270873",
            "telephone_number": "317-887-7725",
            "fax_number": "317-887-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8686 MADISON AVE",
            "address_2": "SUITE F",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462277207",
            "telephone_number": "317-884-3725",
            "fax_number": "317-881-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND OLE DOCS OF THE SOUTHSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSTONE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "317-884-3725",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RR MEDICARE NUMBER",
            "identifier": "CI4722",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "5457630002",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Indiana Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anna Gramling, MD
• Tricia Grams
• Richard K Grana, PHD
• Grand Old Docs of the Southside (Central Indiana Medical Group)
• Grand Ole Docs of the Southside (Central Indiana Medical Group)
• Grand Ole Docs of the Southside, LLC (Central Indiana Medical Group)
• Areli Grande
• Jill Grande, BCBA
• Ana Grandinetti, MD
• Zoe Elizabeth Grandon, RBT

• Family Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.