NPIMap

Organization Active NPI

State of Indiana, Auditor of State

Doing business as NeuroDiagnostic Institute

  • Psychiatric Hospital
  • Indianapolis, IN
National Provider Identifier
1174654305
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF INDIANA, AUDITOR OF STATE
Doing business as
NeuroDiagnostic Institute
Practice address
5435 East 16TH Street
Indianapolis, IN 46218-5101
Phone
(317) 941-4000
Fax
(317) 941-4378
NPI assigned
Mar 8, 2007
Last updated
Jan 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Authorized official

Name
Donna L Rutherford
Title
Controller, Indiana Family & Social
Phone
(317) 232-7862

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

5435 East 16TH Street
Indianapolis, IN 46218-5101

Mailing address

5435 East 16TH Street
Indianapolis, IN 46218-5101
Phone (317) 941-4000

Other names 1

  • NeuroDiagnostic Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080725000471 IN Part A Provider - Hospital 1759280118 Practice locations: Indianapolis, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174654305. Details of each certification follow.

Hospital certification: CCN 154008

Legal name
STATE OF INDIANA AUDITOR OF STATE
Doing business as
NEURODIAGNOSTIC INSTITUTE
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
May 23, 2019
Beds
159
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
5435 E 16TH St
Indianapolis, IN 46218-4869
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Neurodiagnostic InstituteCCN 154008 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Indiana State Department of32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeffrey Wedding Individual Corporate Officer Jan 1, 2020
Corporate DirectorDirector of Operations Jan 1, 2020
W-2 Managing EmployeeDirector of Operations Jan 1, 2020 100%
State of Indiana Auditor of State Organization, Indianapolis, IN Operational/Managerial Control Sep 16, 2015 100%
Katrina Norris Individual W-2 Managing EmployeeExecutive Director Indiana State PS Feb 25, 2019 100%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evansville State HospitalEvansville, IN, CCN 154056 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 22, 2010
Madison State HospitalMadison, IN, CCN 154019 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
Richmond State HospitalRichmond, IN, CCN 154018 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Indiana Veterans HomeWest Lafayette, IN, CCN 155787 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 21, 2011

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1174654305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 EAST 16TH STREET",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462185101",
            "telephone_number": "317-941-4000",
            "fax_number": "317-941-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5435 EAST 16TH STREET",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462185101",
            "telephone_number": "317-941-4000",
            "fax_number": "317-941-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF INDIANA, AUDITOR OF STATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "RUTHERFORD",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CONTROLLER, INDIANA FAMILY & SOCIAL",
        "authorized_official_telephone_number": "317-232-7862"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NeuroDiagnostic Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.