NPIMap

Organization Active NPI

Pediatric Specialty Associates, Inc

  • Early Intervention Provider Agency
  • Indianapolis, IN
National Provider Identifier
1336212638
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
PEDIATRIC SPECIALTY ASSOCIATES, INC
Practice address
6437 Rucker Rd Ste D
Indianapolis, IN 46220-4868
Phone
(317) 405-9016
Fax
(888) 654-4116
NPI assigned
Nov 16, 2006
Last updated
May 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Authorized official

Name
Mrs. Cynthia Holtz
Title
Owner/Director
Phone
(317) 405-9016

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Day Training/Habilitation Specialist 373H00000X NU
Occupational Therapy Assistant 224Z00000X NU
Physical Therapist 225100000X NU
Pediatric Physical Therapist 2251P0200X NU
Speech-Language Pathologist 235Z00000X NU
Early Intervention Provider Agency 252Y00000X NU Primary

Addresses

Primary practice location

6437 Rucker Rd Ste D
Indianapolis, IN 46220-4868

Mailing address

6437 Rucker Rd Ste D
Indianapolis, IN 46220-4868
Phone (317) 405-9016

Other identifiers 1

IdentifierTypeStateIssuer
200717440MedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Specialty Associates Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 72

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 72

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1336212638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6437 RUCKER RD STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204868",
            "telephone_number": "317-405-9016",
            "fax_number": "888-654-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6437 RUCKER RD STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204868",
            "telephone_number": "317-405-9016",
            "fax_number": "888-654-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPECIALTY ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2022-05-13",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "317-405-9016",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200717440",
            "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 May 13, 2022; 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.