Terre Haute Pulmonary & Pediatric Clinic, LLC
Organization Active NPI Internal Medicine Physician · Dugger, IN
NPI 1215045901 · NPPES record last updated Sep 29, 2016
Key facts
- NPI
- 1215045901
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 01045492A (IN)
- Legal business name
- TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
- Practice address
- 1005 S 3Rd St
Dugger, IN 47848-5011 - Phone
- (812) 648-2231
- Fax
- (812) 648-2968
- NPI assigned
- Aug 25, 2006
- Reactivated
- Apr 30, 2008
- Organization subpart
- No
Authorized official
- Name
- Trupti A Bhuptani, MD
- Title
- Co Owner MD
- Phone
- (812) 234-6053
Other NPIs on the same Medicare enrollment 7
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0960976 | Dugger Medical Clinic | Certificate of waiver | May 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040527001234 | IN | Part B Supplier - Clinic/Group Practice | 2062493752 |
Receives reassigned benefits from 10 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Greencastle, IN; Washington, IN; Sullivan, IN; Terre Haute, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 01045492A | IN | Yes |
| Internal Medicine Physician |
207R00000X | 01055950A | IN | |
| Internal Medicine Physician |
207R00000X | 01052847A | IN | |
| Pulmonary Disease Physician |
207RP1001X | 01052847A | IN | |
| General Practice Physician |
208D00000X | 01045492A | IN |
Addresses
Primary practice location
1005 S 3Rd St
Dugger, IN 47848-5011
Mailing address
4525 S Springhill JCT
Terre Haute, IN 47802-4563
Phone (812) 234-6053
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182180D | Other | IN | DESHPANDE MEDICARE # |
| 200314660 | Medicaid | IN | AJAY DESHPANDE MEDICAID # |
| 200111590 | Medicaid | IN | PUROHIT MEDICAID # |
| 182180F | Other | IN | PUROHIT MCR # |
| 200386870 | Medicaid | IN | SHREELEKHA MEDICAID # |
| 200391150D | Medicaid | IN | MEDICAID # DUGGER |
Other names
- Dugger Medical Clinic
Other providers in Dugger, IN
All providers in Dugger, IN · Internal Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.