NPIMap

Individual provider Active NPI

Glen Ehicheoya Oriaifo, MD

  • Psychiatry Physician
  • Vincennes, IN
National Provider Identifier
1104271618
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01083103A Issued in IN
Practice address
515 Bayou St
Vincennes, IN 47591-1034
Phone
(812) 886-6800
Fax
(812) 886-6809
NPI assigned
May 3, 2016
Last updated
Sep 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 01083103A IN
Student in an Organized Health Care Education/Training Program 390200000X NU
Psychiatry Physician 2084P0800X 01083103A IN Primary

Addresses

Primary practice location

515 Bayou St
Vincennes, IN 47591-1034

Mailing address

1160 E Saint Clair St
Vincennes, IN 47591-4853
Phone (812) 885-3106

Other practice location 1

1906 Belleview Ave
Carilion Clinic Roanoke Memorial Hospital
Roanoke, VA 24014
Phone (540) 981-7000

Other practice location 2

707 N Michigan St Ste 400
South Bend, IN 46601
Phone (574) 647-8470

Other identifiers 3

IdentifierTypeStateIssuer
300042757MedicaidIN
01083103AOtherINLICENSE
01083103BOtherINCSR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201009000770 IN Practitioner - Psychiatry 4385938604 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Good Samaritan HospitalGroup PAC ID 9436061918, 11 clinicians
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

520 S 7TH St
Vincennes, IN 47591-1038

707 N Michigan St
400 BMG Behavioral Health South Bend
South Bend, IN 46601-1071
Phone (574) 647-8470

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01083103AINMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Good Samaritan Family Health Center, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Good Samaritan Family Health Center, Inc CurrentSince Jul 1, 2023 Accepting new patients
Beacon Medical Group Inc CurrentSince Oct 1, 2024 Accepting new patients
Brentwood Meadows Physician Group LLC Psychiatry CurrentSince Jun 25, 2024 Accepting new patients
Beacon Medical Group, Inc. Psychiatry CurrentSince Oct 1, 2024 Accepting new patients
Good Samaritan Hospital Psychiatry CurrentSince Aug 1, 2020 Accepting new patients
Good Samaritan Hospital Physician Services, Inc Current Accepting new patients
Good Samaritan Hospital CurrentSince Aug 1, 2020 Accepting new patients

Locations

4488 Roslin Rd
Newburgh, IN 47630
Phone (812) 710-4038

707 N Michigan St
Ste 400
South Bend, IN 46601
Phone (574) 647-4500

1027 Washington Ave
Vincennes, IN 47591
Phone (812) 494-7500

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

121 Buntin St
Ste 1
Vincennes, IN 47591
Phone (812) 885-2718

515 Bayou St
Vincennes, IN 47591
Phone (812) 886-0907

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

2007 State St
Washington, IN 47501
Phone (812) 254-1558

Interoperability endpoints

  • Direct secure messaging: goriaifo218869@direct.deaconess.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1104271618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 E SAINT CLAIR ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914853",
            "telephone_number": "812-885-3106",
            "fax_number": "812-885-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BAYOU ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911034",
            "telephone_number": "812-886-6800",
            "fax_number": "812-886-6809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Belleview Ave",
            "address_2": "Carilion Clinic Roanoke Memorial Hospital",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "24014",
            "country_code": "US",
            "telephone_number": "540-981-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "707 N Michigan St Ste 400",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "46601",
            "country_code": "US",
            "telephone_number": "574-647-8470",
            "fax_number": "574-647-8475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ORIAIFO",
        "first_name": "GLEN",
        "middle_name": "EHICHEOYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-03",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "01083103A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01083103A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300042757",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "01083103A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSR",
            "identifier": "01083103B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.