Ima East Primary Care

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

01066805A Issued in IN

Legal business name

IMA EAST PRIMARY CARE

Practice address

2605 E Creeks Edge Dr
Bloomington, IN 47401-8368

Phone

(812) 355-2300

Fax

(812) 355-3251

NPI assigned

Aug 6, 2009

Organization subpart

Yes

Parent organization

IMA, INC.As reported in NPPES

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

Authorized official

Name

Wesley W Ratlif, M.D.

Title

President

Phone

(812) 331-3400

Specialties & licenses 1

Addresses

Tax ID family

Ima East Primary Care4 organizations share this tax ID, including this one

Part of

Ima East Primary Care

Other organizations with this tax ID 3

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

• Ima Inc Laboratory

  • Clinical Medical Laboratory
  • Bloomington, IN
  • NPI 1588669667
  NPD tax ID
• Ima, Inc.

  • Sleep Disorder Diagnostic Clinic/Center
  • Bloomington, IN
  • NPI 1811182298
  NPD tax ID
• Ima, Inc. Physical Therapy

  • Physical Therapy Clinic/Center
  • Bloomington, IN
  • NPI 1750564274
  NPD tax ID

Locations

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1184855272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-355-6900",
            "fax_number": "812-355-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 E CREEKS EDGE DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018368",
            "telephone_number": "812-355-2300",
            "fax_number": "812-355-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMA EAST PRIMARY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMA, INC.",
        "enumeration_date": "2009-08-06",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "RATLIF",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-331-3400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IN",
            "license": "01066805A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmed Ibrahim, MD
• Icr Operating Subsidiary, LLC
• Ilic Renal and Hypertension Associates, P.a.
• Ljubomir M Ilic, MD
• Dwain Clark Illman, M.D.
• Ima Inc Laboratory
• Ima, Inc.
• Ima, Inc.
• Ima, Inc. Physical Therapy
• In Bloom Counseling and Therapy Services, LLC

• Sports Medicine (Family Medicine) Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Sports Medicine (Family Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.