NPIMap

Organization Active NPI

Apollo Medical Group of Jeffersonville LLC

  • Anesthesiology Physician
  • Jeffersonville, IN
National Provider Identifier
1124607205
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
APOLLO MEDICAL GROUP OF JEFFERSONVILLE LLC
Practice address
2990 Gottbrath Pkwy
Jeffersonville, IN 47130-8901
Phone
(812) 671-0990
NPI assigned
Apr 6, 2021
Last updated
Apr 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Authorized official

Name
Robin Van Sprundel
Title
Director of Administration
Phone
(941) 725-1198

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary
Certified Registered Nurse Anesthetist 367500000X

Addresses

Primary practice location

2990 Gottbrath Pkwy
Jeffersonville, IN 47130-8901

Mailing address

PO Box 3903
Springfield, IL 62708-3903
Phone (941) 360-1566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210521000410 IN Part B Supplier - Clinic/Group Practice 8729487897 Receives reassigned benefits from 52 practitioners
Practice locations: Jeffersonville, IN

National Provider Directory

National Provider Directory

Locations

2990 Gottbrath Pkwy
Jeffersonvlle, IN 47130
Phone (812) 670-0990

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1124607205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3903",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627083903",
            "telephone_number": "941-360-1566",
            "fax_number": "941-358-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 GOTTBRATH PKWY",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308901",
            "telephone_number": "812-671-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APOLLO MEDICAL GROUP OF JEFFERSONVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-06",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "VAN SPRUNDEL",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "941-725-1198"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; 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.