Individual provider Active NPI

Samuel David Garrison, MD

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1174378947
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
355 W 16TH St Ste 2364
Indianapolis, IN 46202-2279
Phone
(317) 963-7307
NPI assigned
Apr 23, 2024
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X IN Primary

Addresses

Primary practice location

355 W 16TH St Ste 2364
Indianapolis, IN 46202-2279

Mailing address

355 W 16TH St Ste 2364
Indianapolis, IN 46202-2279
Phone (317) 963-7307

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240601000343 IN Order and Referring Only - PsychiatryPractitioner - Psychiatry 5597207894

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1713830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1174378947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST STE 2364",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022279",
            "telephone_number": "317-963-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST STE 2364",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022279",
            "telephone_number": "317-963-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARRISON",
        "first_name": "SAMUEL",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-23",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.