Main Street Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01034958 Issued in IN

Legal business name

MAIN STREET CLINIC

Practice address

117 S Main St
Bluffton, IN 46714-2047

Phone

(260) 824-9265

Fax

(260) 824-9267

NPI assigned

Mar 7, 2018

Organization subpart

No

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

Authorized official

Name

John J. Greenman, M.D.

Title

M.D/Ceo-President

Phone

(260) 824-9265

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Wells Medical Services Former legal business name

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520380800000",
    "number": "1093217846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S MAIN ST",
            "city": "BLUFFTON",
            "state": "IN",
            "postal_code": "467142047",
            "telephone_number": "260-824-9265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S MAIN ST",
            "city": "BLUFFTON",
            "state": "IN",
            "postal_code": "467142047",
            "telephone_number": "260-824-9265",
            "fax_number": "260-824-9267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2018-03-07",
        "status": "A",
        "authorized_official_last_name": "GREENMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "M.D/CEO-PRESIDENT",
        "authorized_official_telephone_number": "260-824-9265",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01034958",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IN",
            "license": "01034958",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100101710A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wells Medical Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Russel Jerome Legreid II, M.D.
• Roger D. Lemmen, M.D.
• Richard J Leo, M.D.
• Loving Shepherd International Services & Foundation, Inc.
• Lutheran HBP Services, LLC
• Abby Malloy
• Marica C. Sell
• Markle Medical Center, Inc
• Pekkakuzhiyil M Mathew, M.D.
• Matthew D. Mitchell O.D., LLC

• All providers in Bluffton, IN
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; 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.