NPIMap

Organization Active NPI

Broad Ripple Family Dental, LLC

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1073840393
Registry record updated Nov 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010357A Issued in IN
Legal business name
BROAD RIPPLE FAMILY DENTAL, LLC
Practice address
6117 N College Ave
Indianapolis, IN 46220-2233
Phone
(317) 257-3368
NPI assigned
Nov 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2009

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

Authorized official

Name
Dr. Gina Elrod
Title
Dentist
Phone
(317) 257-3368

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12007547A IN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12010049A IN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12010357A IN Primary

Addresses

Primary practice location

6117 N College Ave
Indianapolis, IN 46220-2233

Mailing address

6117 N. College
Indianapolis, IN 46220
Phone (317) 257-3368

Other identifiers 1

IdentifierTypeStateIssuer
100061910AMedicaidIN

National Provider Directory

National Provider Directory

Locations

6117 N College Ave
Indianapolis, IN 46220
Phone (317) 257-3368

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1073840393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6117 N. COLLEGE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46220",
            "telephone_number": "317-257-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6117 N COLLEGE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462202233",
            "telephone_number": "317-257-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD RIPPLE FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "ELROD",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "317-257-3368",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007547A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010049A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010357A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100061910A",
            "state": "IN"
        }
    ],
    "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 6, 2009; 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.