NPIMap

Organization Active NPI

Dekalb Memorial Hospital, Inc

Doing business as Dekalb Health Medical Group

  • General Practice Physician
  • Auburn, IN
National Provider Identifier
1073886560
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
DEKALB MEMORIAL HOSPITAL, INC
Doing business as
Dekalb Health Medical Group
Practice address
1310 E 7TH St
Suite G
Auburn, IN 46706-2534
Phone
(260) 920-2000
Fax
(260) 920-2005
NPI assigned
Feb 15, 2012
Last updated
Sep 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Authorized official

Name
Craig Polkow
Title
Ceo
Phone
(260) 925-4600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Otolaryngology Physician 207Y00000X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

1310 E 7TH St
Suite G
Auburn, IN 46706-2534

Mailing address

PO Box 623
Auburn, IN 46706-0623
Phone (260) 927-8105

Other identifiers 1

IdentifierTypeStateIssuer
100104110IMedicaidIN

Other names 1

  • DEKALB HEALTH MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1073886560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 623",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467060623",
            "telephone_number": "260-927-8105",
            "fax_number": "260-927-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E 7TH ST",
            "address_2": "SUITE G",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467062534",
            "telephone_number": "260-920-2000",
            "fax_number": "260-920-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "POLKOW",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-925-4600"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100104110I",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEKALB HEALTH MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Auburn, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.