NPIMap

Organization Active NPI

St. Joseph Primary Care, LLC

Doing business as Sycamore Pediatrics and Adolescents

  • Pediatrics Physician
  • Greentown, IN
National Provider Identifier
1336342286
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01060986A Issued in IN
Legal business name
ST. JOSEPH PRIMARY CARE, LLC
Doing business as
Sycamore Pediatrics and Adolescents
Practice address
712 W Main St
Greentown, IN 46936-1045
Phone
(765) 628-3317
Fax
(765) 628-5979
NPI assigned
Jun 7, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James E. Whitfield, MD
Title
Medical Director
Phone
(765) 457-8381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01060986A IN Primary

Addresses

Primary practice location

712 W Main St
Greentown, IN 46936-1045

Mailing address

712 W Main St
Greentown, IN 46936-1045
Phone (765) 628-3317

Other identifiers 2

IdentifierTypeStateIssuer
000000378656OtherINBLUE CROSS BLUE SHIELD
1285615336OtherINNPI

Other names 1

  • Sycamore Pediatrics and Adolescents Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Primary LLC13 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.

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336342286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 W MAIN ST",
            "city": "GREENTOWN",
            "state": "IN",
            "postal_code": "469361045",
            "telephone_number": "765-628-3317",
            "fax_number": "765-628-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 W MAIN ST",
            "city": "GREENTOWN",
            "state": "IN",
            "postal_code": "469361045",
            "telephone_number": "765-628-3317",
            "fax_number": "765-628-5979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITFIELD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "765-457-8381",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01060986A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000378656",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1285615336",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sycamore Pediatrics and Adolescents",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greentown, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.