NPIMap

Organization Active NPI

Indianapolis Neurosurgical Group

  • Neurological Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1306065149
Registry record updated Dec 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
01024604 Issued in IN
Legal business name
INDIANAPOLIS NEUROSURGICAL GROUP
Practice address
201 Pennsylvania Pkwy
200
Indianapolis, IN 46280-2301
Phone
(317) 396-1300
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2009

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

Authorized official

Name
Derek Cantrell
Title
Exec Director Finance
Phone
(317) 396-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X 01024604 IN Primary

Addresses

Primary practice location

201 Pennsylvania Pkwy
200
Indianapolis, IN 46280-2301

Mailing address

8333 Naab Rd
255
Indianapolis, IN 46260-5924
Phone (317) 396-1300

Other identifiers 1

IdentifierTypeStateIssuer
100318390NMedicaidIN

Other names 1

  • Goodman Campbell Brain and Spine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Goodman Campbell Brain and Spine21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1306065149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8333 NAAB RD",
            "address_2": "255",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605924",
            "telephone_number": "317-396-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PENNSYLVANIA PKWY",
            "address_2": "200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462802301",
            "telephone_number": "317-396-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANAPOLIS NEUROSURGICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "EXEC DIRECTOR FINANCE",
        "authorized_official_telephone_number": "317-396-1300"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "IN",
            "license": "01024604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100318390N",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodman Campbell Brain and Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 29, 2009; 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.