NPIMap

Organization Active NPI

St Joseph Primary LLC

Doing business as Kokomo Gastroenterology & Hepatology

  • Gastroenterology Physician
  • Kokomo, IN
National Provider Identifier
1265489975
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
0104783A Issued in IN
Legal business name
ST JOSEPH PRIMARY LLC
Doing business as
Kokomo Gastroenterology & Hepatology
Practice address
615 Saint Joseph Dr
Kokomo, IN 46901-1890
Phone
(765) 236-0610
NPI assigned
May 28, 2006
Last updated
Nov 16, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Authorized official

Name
Andrew Kellar
Title
Regional Practice Administrator
Phone
(765) 457-8381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 0104783A IN Primary

Addresses

Primary practice location

615 Saint Joseph Dr
Kokomo, IN 46901-1890

Mailing address

615 Saint Joseph Dr
Kokomo, IN 46901-1890
Phone (765) 236-0610

Other identifiers 1

IdentifierTypeStateIssuer
20031200FMedicaidIN

Other names 1

  • Kokomo Gastroenterology & Hepatology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Primary LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

615 Saint Joseph Dr
Kokomo, IN 46901
Phone (765) 236-0610

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1265489975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SAINT JOSEPH DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469011890",
            "telephone_number": "765-236-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SAINT JOSEPH DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469011890",
            "telephone_number": "765-236-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH PRIMARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "KELLAR",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "REGIONAL PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "765-457-8381"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "0104783A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20031200F",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kokomo Gastroenterology & Hepatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.