Active NPI
Thomas Buckner
- Mental Illness Community Based Residential Treatment Facility
- Gary, IN
National Provider Identifier
1184094013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- Practice address
- 1100 W 6TH Ave
Gary, IN 46402-1711 - Phone
- (219) 885-4264
- NPI assigned
- Oct 5, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Mental Illness Community Based Residential Treatment Facility | 320800000X | Primary |
Addresses
Primary practice location
1100 W 6TH Ave
Gary, IN 46402-1711
Mailing address
1100 W 6TH Ave
Gary, IN 46402-1711
Phone (219) 885-4264
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444003200000",
"number": "1184094013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 W 6TH AVE",
"city": "GARY",
"state": "IN",
"postal_code": "464021711",
"telephone_number": "219-885-4264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 W 6TH AVE",
"city": "GARY",
"state": "IN",
"postal_code": "464021711",
"telephone_number": "219-885-4264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKNER",
"first_name": "THOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-05",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gary, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.