NPIMap

Organization Active NPI

Landmark Medical of Tennessee PC

  • General Practice Physician
  • Indianapolis, IN
National Provider Identifier
1285359752
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LANDMARK MEDICAL OF TENNESSEE PC
Practice address
10475 Crosspoint Blvd Ste 250
Indianapolis, IN 46256-3387
Phone
(657) 400-5180
NPI assigned
Oct 7, 2022
Last updated
Jan 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Authorized official

Name
Christopher DennisNPI 1811068349
Title
Chief Medical Officer
Phone
(657) 237-2450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

10475 Crosspoint Blvd Ste 250
Indianapolis, IN 46256-3387

Mailing address

7755 Center Ave Ste 630
Huntington Beach, CA 92647-9152

Other names 1

  • Indiana Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230308000667 IN Part B Supplier - Clinic/Group Practice 8527453851 Receives reassigned benefits from 2 practitioners
Practice locations: Indianapolis, IN

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Landmark Medical of Tennessee PC13 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.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1665100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1285359752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7755 CENTER AVE STE 630",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926479152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CROSSPOINT BLVD STE 250",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462563387",
            "telephone_number": "657-400-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANDMARK MEDICAL OF TENNESSEE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-07",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "657-237-2450"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Indiana",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jan 30, 2024; 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.