Active NPI
Joseph D Gifford, MD
- Anatomic Pathology & Clinical Pathology Physician
- Peru, IN
National Provider Identifier
1194706150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 01020791A
- Practice address
- 275 W 12TH St
Peru, IN 46970-1638 - Phone
- (765) 472-8000
- NPI assigned
- Nov 8, 2005
- Last updated
- Oct 31, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nuclear Medicine Physician | 207U00000X | 01020791A | IN | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 01020791A | IN | Primary |
Addresses
Primary practice location
275 W 12TH St
Peru, IN 46970-1638
Mailing address
5700 Southwyck Blvd
Toledo, OH 43614-1509
Phone (800) 288-8325
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 220004842 | Other | RAILROAD | |
| 100084220B | Medicaid | IN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01020791A | IN | MD | Nuclear Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wabash County Auditor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Wabash County Health Department
- Public Health or Welfare Agency
- Wabash, IN
- NPI 1225229685
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383177600000",
"number": "1194706150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 SOUTHWYCK BLVD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436141509",
"telephone_number": "800-288-8325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W 12TH ST",
"city": "PERU",
"state": "IN",
"postal_code": "469701638",
"telephone_number": "765-472-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIFFORD",
"first_name": "JOSEPH",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-08",
"last_updated": "2013-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207U00000X",
"taxonomy_group": "",
"desc": "Nuclear Medicine",
"state": "IN",
"license": "01020791A",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IN",
"license": "01020791A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "220004842",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100084220B",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peru, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.