Gillum Facial Plastic Surgery, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

0155912A Issued in IN

Legal business name

GILLUM FACIAL PLASTIC SURGERY, PC

Practice address

330 N Wabash Ave
Ste 210
Marion, IN 46952-2600

Phone

(765) 651-4278

Fax

(765) 664-6445

NPI assigned

Jan 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Timothy G Gillum, MDNPI 1316994791

Title

Owner

Phone

(765) 651-4278

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6874/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• Timothy G Gillum, MD

  • Specialist
  • Marion, IN
  • NPI 1316994791
  Medicare reassignment Care Compare group NPD Authorized official
• Craig Peel, FNP-C

  • Primary Care Nurse Practitioner
  • Marion, IN
  • NPI 1356961809
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063563617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2063",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462062063",
            "telephone_number": "765-651-4278",
            "fax_number": "765-664-6445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N WABASH AVE",
            "address_2": "STE 210",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522600",
            "telephone_number": "765-651-4278",
            "fax_number": "765-664-6445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLUM FACIAL PLASTIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GILLUM",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-651-4278",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "0155912A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denita Sue Germaine, RD,CD
• Katherine Downing Gibson, MA, CCC-SLP
• Lauren K Gibson, MSW
• Mi'Esha Gibson, RBT
• Ashley Gilliam
• Timothy G Gillum, MD
• Henry S Gindt, MD
• Kylie Ginn
• Gloria Jane Goens, LCSW
• Amanda Kay Goins, NP

• Specialist in Marion, IN
• Providers in Marion, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.