NPIMap

Organization Active NPI

Aeg Indiana Professional PC

  • Optometrist
  • Warsaw, IN
National Provider Identifier
1043944127
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG INDIANA PROFESSIONAL PC
Practice address
2250 N Pointe Dr
Warsaw, IN 46582-9042
Phone
(574) 267-3515
Fax
(314) 741-4947
NPI assigned
Jul 13, 2022
Last updated
Aug 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

Name
Melissa Allison
Title
Senior Director RCM/MVC
Phone
(618) 462-9818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

2250 N Pointe Dr
Warsaw, IN 46582-9042

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6241
Phone (618) 462-9818

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220829000590 IN Part B Supplier - Clinic/Group Practice 2365826179 Receives reassigned benefits from 43 practitioners
Practice locations: West Harrison, IN; Warsaw, IN; Terre Haute, IN; Saint John, IN; Plymouth, IN; Newburgh, IN; New Castle, IN; Marion, IN…

National Provider Directory

National Provider Directory

Locations

609 N Halleck St
Demotte, IN 46310
Phone (219) 981-3673

5525 Georgetown Rd
Indianapolis, IN 46254
Phone (317) 297-1788

5525 Georgetown Rd
Ste J
Indianapolis, IN 46254
Phone (317) 297-1788

2315 W Jefferson St
Kokomo, IN 46901
Phone (765) 342-3686

711 N River Dr
Marion, IN 46952
Phone (765) 388-3033

1500 Washington St
New Castle, IN 47362
Phone (317) 529-9364

9270 Wicker Ave
Saint John, IN 46373
Phone (219) 627-3133

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1043944127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026241",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 N POINTE DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465829042",
            "telephone_number": "574-267-3515",
            "fax_number": "314-741-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG INDIANA PROFESSIONAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "SENIOR DIRECTOR RCM/MVC",
        "authorized_official_telephone_number": "618-462-9818"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warsaw, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.