Bloomington ENT PC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

01040385A Issued in IN

Legal business name

BLOOMINGTON ENT PC

Practice address

1791 W 3Rd St
Bloomington, IN 47404-5029

Phone

(812) 335-1300

Fax

(812) 335-0300

NPI assigned

Jan 26, 2006

Last updated

Apr 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jesse Phillips, MD

Title

Owner

Phone

(812) 335-1300

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1306816665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 W 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474045029",
            "telephone_number": "812-335-1300",
            "fax_number": "812-335-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 W 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474045029",
            "telephone_number": "812-335-1300",
            "fax_number": "812-335-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ENT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-335-1300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01040385A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO",
            "identifier": "546541P",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000209641",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2440326",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5818093",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Otolaryngology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; 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.