Diagnostic Medicine P.C.
Organization Active NPI Critical Care Medicine (Internal Medicine) Physician · Plymouth, IN
NPI 1255439022 · NPPES record last updated Jun 28, 2023
Key facts
- NPI
- 1255439022
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Care Medicine (Internal Medicine) Physician 207RC0200X
- License
- 50004231 (IN)
- Legal business name
- DIAGNOSTIC MEDICINE P.C.
- Practice address
- 113 N Michigan St
Plymouth, IN 46563-2132 - Phone
- (574) 250-3178
- Fax
- (574) 250-3178
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Londa Aldridge, FNP
- Title
- Partner
- Phone
- (574) 936-2643
Practitioners 5
-
James Timothy Aldridge, D.O.
-
Londa Aldridge, FNP
-
Alissa Whittaker, FNP
-
Eric Tripp, M.D.
-
Peter E Sices, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2268760 | Diagnostic Medicine PC | Certificate of waiver | Sep 15, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221018000365 | IN | Part B Supplier - Clinic/Group Practice | 5890161756 |
Receives reassigned benefits from 3 practitioners Practice locations: Plymouth, IN; Rochester, IN |
National Provider Directory
Locations
1919 Lake Ave
#108
Plymouth, IN 46563
Phone (219) 935-3602
113 N Michigan St
Plymouth, IN 46563
Phone (574) 936-2643
1919 Lake Ave
Ste 108
Plymouth, IN 46563
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician |
207RC0200X | 50004231 | IN | Yes |
Addresses
Primary practice location
113 N Michigan St
Plymouth, IN 46563-2132
Mailing address
113 N Michigan St
Plymouth, IN 46563-2132
Phone (574) 936-2643
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110207420 | Other | IN | MEDICARE RAILROAD |
| 200281260 | Medicaid | IN |
Other providers in Plymouth, IN
- Sherry C Davis
- Ashley De Leon
- Heather Delp
- Dental Center of Plymouth LLC
- Monali Desai
- Patricia Dietz
- Discover Health Chiropractic LLC
- Alexis Dorough
- Jennifer Dudash
- Tai Duncan
All providers in Plymouth, IN · Critical Care Medicine (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 Jun 28, 2023. 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.