Individual provider Active NPI

Nishanie Gunawardane, D.O.

  • Psychiatry Physician
  • Bloomington, IN
National Provider Identifier
1235440082
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
02004583A Issued in IN
Practice address
645 S Rogers St
Bloomington, IN 47403-2353
Phone
(812) 339-1691
Fax
(812) 337-2438
NPI assigned
Jun 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 02004583A IN Primary
Addiction Psychiatry Physician 2084P0802X 02004583A IN

Addresses

Primary practice location

645 S Rogers St
Bloomington, IN 47403-2353

Mailing address

645 S Rogers St
Bloomington, IN 47403-2353
Phone (812) 339-1691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150811005724 IN Practitioner - PsychiatryPractitioner - Addiction Medicine 4486969003 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Addiction Medicine
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Group practices
Centerstone of Indiana IncGroup PAC ID 9436138427, 114 clinicians
Centerstone Health Services IncGroup PAC ID 1850497173, 25 clinicians

Practice addresses (Care Compare)

645 S Rogers St
Bloomington, IN 47403-2353
Phone (812) 339-1691

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02004583AINMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone Health Services, Inc CurrentSince Mar 13, 2020 Accepting new patients
Centerstone Health Services, Inc. Current Accepting new patients
Centerstone of Indiana, Inc. CurrentSince Aug 3, 2015 Accepting new patients
Centerstone Health Services, Inc. CurrentSince Mar 13, 2020 Accepting new patients
Centerstone of Indiana, Inc. CurrentSince Aug 3, 2015 Accepting new patients
Major Hospital Past Accepting new patients
Centerstone Health Services, Inc. Past Accepting new patients

Locations

645 S Rogers St
Ste A
Bloomington, IN 47403
Phone (812) 269-5092

645 S Rogers St
Bloomington, IN 47403
Phone (812) 339-1691

720 N Marr Rd
Ste A
Columbus, IN 47201
Phone (812) 314-3400

720 N Marr Rd
Columbus, IN 47201
Phone (812) 314-3400

390 Erie Ave
Ste A
Connersville, IN 47331
Phone (812) 325-7492

831 Dillon Dr
Ste A
Richmond, IN 47374
Phone (765) 200-7900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24341/brand/1/csg/1/fhir/r4
  • Direct secure messaging: nishanie.gunawardane.1@24341.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1277596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1235440082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032353",
            "telephone_number": "812-339-1691",
            "fax_number": "812-337-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032353",
            "telephone_number": "812-339-1691",
            "fax_number": "812-337-2438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNAWARDANE",
        "first_name": "NISHANIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-27",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "02004583A",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "IN",
            "license": "02004583A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.