NPIMap

Organization Active NPI

Northside ENT, Inc

  • Audiologist
  • Carmel, IN
National Provider Identifier
1083656672
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
23002085A Issued in IN
Legal business name
NORTHSIDE ENT, INC
Practice address
12065 Old Meridian St
Suite 205
Carmel, IN 46032-8773
Phone
(317) 844-5656
Fax
(317) 575-3795
NPI assigned
Jun 11, 2006
Last updated
Jun 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Authorized official

Name
Darvina L Gallon
Title
Director of Operations
Phone
(317) 818-5447

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 23002085A IN Primary

Addresses

Primary practice location

12065 Old Meridian St
Suite 205
Carmel, IN 46032-8773

Mailing address

12065 Old Meridian Street
Suite 205
Carmel, IN 46032-8772
Phone (317) 844-5656

Other identifiers 1

IdentifierTypeStateIssuer
100062900AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000026 IN Part B Supplier - Clinic/Group Practice 6709790330 Receives reassigned benefits from 12 practitioners
Practice locations: Carmel, IN; Lebanon, IN

National Provider Directory

National Provider Directory

Locations

12065 Old Meridian St
Ste 1
Carmel, IN 46032

12065 Old Meridian St
Ste 205
Carmel, IN 46032
Phone (317) 844-5656

8803 N Meridian St
Ste 200
Indianapolis, IN 46260
Phone (317) 705-7050

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1083656672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12065 OLD MERIDIAN STREET",
            "address_2": "SUITE 205",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460328772",
            "telephone_number": "317-844-5656",
            "fax_number": "317-575-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12065 OLD MERIDIAN ST",
            "address_2": "SUITE 205",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460328773",
            "telephone_number": "317-844-5656",
            "fax_number": "317-575-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE ENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "GALLON",
        "authorized_official_first_name": "DARVINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "317-818-5447"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23002085A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100062900A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.