NPIMap

Organization Active NPI

Allied Physicians of Michiana, LLC

Doing business as Northern Indiana Vascualr Institute

  • Vascular Surgery Physician
  • Mishawaka, IN
National Provider Identifier
1154832178
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
ALLIED PHYSICIANS OF MICHIANA, LLC
Doing business as
Northern Indiana Vascualr Institute
Northern Indiana Vascular Institute
Practice address
611 E Douglas Rd Ste 308
Mishawaka, IN 46545-1465
Phone
(574) 236-1888
NPI assigned
Oct 17, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLIED PHYSICIANS OF MICHIANA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Shery Roussarie
Title
Ceo
Phone
(574) 251-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

611 E Douglas Rd Ste 308
Mishawaka, IN 46545-1465

Mailing address

6301 University Commons Ste 230
South Bend, IN 46635-1590

Other names 2

  • Northern Indiana Vascualr Institute Doing business as
  • Northern Indiana Vascular Institute Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Allied Physicians of Michiana LLC4 organizations share this tax ID, including this one
Part of
Allied Physicians of Michiana LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1154832178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS STE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 308",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451465",
            "telephone_number": "574-236-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIED PHYSICIANS OF MICHIANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIED PHYSICIANS OF MICHIANA, LLC",
        "enumeration_date": "2017-10-17",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ROUSSARIE",
        "authorized_official_first_name": "SHERY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "574-251-2100"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Indiana Vascualr Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Indiana Vascular Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.