NPIMap

Organization Active NPI

Indiana Blood and Marrow Transplantation LLC

  • Clinic/Center
  • Indianapolis, IN
National Provider Identifier
1275647083
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
INDIANA BLOOD AND MARROW TRANSPLANTATION LLC
Practice address
8111 S Emerson Ave
Suite 105
Indianapolis, IN 46237-8601
Phone
(317) 528-5500
Fax
(317) 528-7356
NPI assigned
Aug 18, 2006
Last updated
Sep 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Authorized official

Name
Donna Phalen
Title
Director Rev Integrity
Phone
(219) 554-4548

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

8111 S Emerson Ave
Suite 105
Indianapolis, IN 46237-8601

Mailing address

PO Box 781090
Detroit, MI 48278-1090
Phone (317) 528-4800

Other identifiers 1

IdentifierTypeStateIssuer
100131340MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100923000555 IN Part B Supplier - Clinic/Group Practice 2264558626 Receives reassigned benefits from 13 practitioners
Practice locations: Indianapolis, IN

National Provider Directory

National Provider Directory

Locations

1600 Albany St
Ste 6T
Beech Grove, IN 46107
Phone (317) 865-5500

8111 S Emerson Ave
Ste 105
Indianapolis, IN 46237
Phone (317) 528-5500

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1275647083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781090",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781090",
            "telephone_number": "317-528-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8111 S EMERSON AVE",
            "address_2": "SUITE 105",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378601",
            "telephone_number": "317-528-5500",
            "fax_number": "317-528-7356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA BLOOD AND MARROW TRANSPLANTATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "PHALEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "DIRECTOR REV INTEGRITY",
        "authorized_official_telephone_number": "219-554-4548"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100131340",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.