NPIMap

Organization Active NPI

Greenwood Orthopedics PC

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1083688600
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
GREENWOOD ORTHOPEDICS PC
Practice address
1550 E County Line Rd
Suite 200
Indianapolis, IN 46227
Phone
(317) 497-6497
Fax
(317) 497-6400
NPI assigned
Feb 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Authorized official

Name
Richard W Jackson, MD
Title
Physician Owner of Practice
Phone
(317) 497-6497

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1550 E County Line Rd
Suite 200
Indianapolis, IN 46227

Mailing address

1550 E County Line Rd
Suite 200
Indianapolis, IN 46227
Phone (317) 497-6497

Other identifiers 2

IdentifierTypeStateIssuer
0000308039OtherANTHEM
200489270AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040615001192 IN Part B Supplier - Clinic/Group Practice 8022092378 Receives reassigned benefits from 8 practitioners
Practice locations: Greenwood, IN; Indianapolis, IN
O20100930049542 IN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8022092378 Practice locations: Indianapolis, IN

National Provider Directory

National Provider Directory

Locations

1402 E County Line Rd
Ste 100
Indianapolis, IN 46227

2451 Intelliplex Dr
Shelbyville, IN 46176
Phone (317) 392-3211

Practitioners & affiliated clinicians

Practitioners 8

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": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1083688600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 E COUNTY LINE RD",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46227",
            "telephone_number": "317-497-6497",
            "fax_number": "317-497-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 E COUNTY LINE RD",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46227",
            "telephone_number": "317-497-6497",
            "fax_number": "317-497-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWOOD ORTHOPEDICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN OWNER OF PRACTICE",
        "authorized_official_telephone_number": "317-497-6497",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "0000308039",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200489270A",
            "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 Jan 17, 2013; 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.