Organization Active NPI

Nephrology Associates of Indianapolis, LLC

  • Nephrology Physician
  • Indianapolis, IN
National Provider Identifier
1104922582
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
02002905A Issued in IN
Legal business name
NEPHROLOGY ASSOCIATES OF INDIANAPOLIS, LLC
Practice address
6350 Rucker Rd
Suite 103
Indianapolis, IN 46220-4893
Phone
(317) 682-2038
Fax
(317) 920-7482
NPI assigned
Sep 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Authorized official

Name
Mary Burden, D.O.NPI 1598725780
Title
Owner
Phone
(317) 682-2038

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 02002905A IN Primary

Addresses

Primary practice location

6350 Rucker Rd
Suite 103
Indianapolis, IN 46220-4893

Mailing address

PO Box 7203
Fishers, IN 46038-7303
Phone (317) 682-2038

Other identifiers 1

IdentifierTypeStateIssuer
200540580MedicaidIN

National Provider Directory

National Provider Directory

Locations

3520 Guion Rd
#204
Indianapolis, IN 46222
Phone (317) 407-7950

3520 Guion Rd
Ste 103
Indianapolis, IN 46222
Phone (317) 682-2038

6350 Rucker Rd
Ste 103
Indianapolis, IN 46220
Phone (317) 682-2038

Practitioners & affiliated clinicians

Practitioners 2

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": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1104922582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7203",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460387303",
            "telephone_number": "317-682-2038",
            "fax_number": "317-920-7482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6350 RUCKER RD",
            "address_2": "SUITE 103",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204893",
            "telephone_number": "317-682-2038",
            "fax_number": "317-920-7482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEPHROLOGY ASSOCIATES OF INDIANAPOLIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "BURDEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-682-2038",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "02002905A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200540580",
            "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 Dec 20, 2022; 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.