Individual provider Active NPI

Ralph J Marsala, PA-C

  • Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1114953254
Registry record updated Feb 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10000047A Issued in IN
Practice address
9650 E Washington St
Ste 100
Indianapolis, IN 46229-3032
Phone
(317) 890-5500
Fax
(317) 890-5566
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10000047A IN Primary

Addresses

Primary practice location

9650 E Washington St
Ste 100
Indianapolis, IN 46229-3032

Mailing address

250 N Shadeland Ave
Ste 130 Provider Enrollment
Indianapolis, IN 46219-4959

Other identifiers 1

IdentifierTypeStateIssuer
P00924299OtherINRAILROAD MEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090715000673 IN Practitioner - Physician Assistant 9436201811 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10000047AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Care Associates, Inc. CurrentSince Apr 15, 2010 Accepting new patients
Methodist Medical Group Physicians Inc Past Accepting new patients
Major Hospital Past Accepting new patients
Indiana University Health Inc Past Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

5208 Reliable Pkwy
Chicago, IL 60686

9650 E Washington St
Ste 100
Indianapolis, IN 46229
Phone (317) 890-5500

250 N Shadeland Ave
Ste 130
Indianapolis, IN 46219
Phone (317) 962-4836

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393372800000",
    "number": "1114953254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "STE 130 PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9650 E WASHINGTON ST",
            "address_2": "STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293032",
            "telephone_number": "317-890-5500",
            "fax_number": "317-890-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSALA",
        "first_name": "RALPH",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2014-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000047A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00924299",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.