NPIMap

Individual provider Active NPI

David J Gulliver, MD

  • Diagnostic Radiology Physician
  • Indianapolis, IN
National Provider Identifier
1356331292
Registry record updated Oct 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01052292A Issued in IN
Practice address
5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone
(317) 328-5050
Fax
(317) 715-9965
NPI assigned
Oct 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01052292A IN Primary

Addresses

Primary practice location

5901 Technology Center Dr
Indianapolis, IN 46278-6013

Mailing address

5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone (317) 328-5050

Other identifiers 7

IdentifierTypeStateIssuer
001145OtherINSIHO-351158723
070893OtherINHEALTH ALLIANCE-351158723
200248880MedicaidIN
000000082117OtherINANTHEM-351158723
300108363OtherINRR MEDICARE-351158723
000000492346OtherINANTHEM-203778927
Q0071722OtherINCMOSHO351158723&352047427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050124000503 IN Practitioner - Diagnostic Radiology 4688624158 Reassigns benefits to 2 organizations
I20220614000122 CO Practitioner - Diagnostic Radiology 4688624158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Radiology and Interventional Associates IncGroup PAC ID 8729976964, 251 clinicians

Practice addresses (Care Compare)

2890 W Parkside PL
Denver, CO 80221-1417
Phone (614) 340-7740

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
68 of 100Reported as group
Quality
80
Improvement activities
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
69502FLMDPharmacist
01052292AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Radiology and Interventional Associates Inc Diagnostic Radiology CurrentSince Apr 1, 2023 Accepting new patients
Indiana University Radiology Associates, Inc. Diagnostic Radiology CurrentSince Jul 1, 2009 Accepting new patients
St. Vincent Medical Group, Inc. PastSince Aug 14, 2017 Accepting new patients
St Vincent Northwest Radiology LLC Diagnostic Radiology Past Accepting new patients
Rush Memorial Hospital Past Accepting new patients
Cira Michigan PC Diagnostic Radiology Past Accepting new patients
St. Vincent Health Wellness and Preventive Care Institute, Inc. Past Accepting new patients

Locations

5924 Reliable Pkwy
Chicago, IL 60686

10995 Allisonville Rd
Ste 100
Fishers, IN 46038
Phone (317) 842-7928

1701 Senate Blvd
#C6
Indianapolis, IN 46202
Phone (317) 962-9000

2401 W University Ave
Muncie, IN 47303
Phone (765) 747-3111

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1356331292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-328-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-715-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLIVER",
        "first_name": "DAVID",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-23",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01052292A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO-351158723",
            "identifier": "001145",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE-351158723",
            "identifier": "070893",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200248880",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-351158723",
            "identifier": "000000082117",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE-351158723",
            "identifier": "300108363",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-203778927",
            "identifier": "000000492346",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMOSHO351158723&352047427",
            "identifier": "Q0071722",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.