Jetty Heart Clinic of the Indiana Heart Hospital LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

01040154A Issued in IN

Legal business name

JETTY HEART CLINIC OF THE INDIANA HEART HOSPITAL LLC

Practice address

1210 Medical Arts Blvd
Suite 217
Anderson, IN 46011-3439

Phone

(765) 298-4422

Fax

(765) 298-4926

NPI assigned

Sep 4, 2008

Last updated

Oct 21, 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

Thomas A Malasto

Title

Ceo

Phone

(317) 621-8050

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Russell S Dilley, M.D.

  • Vascular Surgery Physician
  • Indianapolis, IN
  • NPI 1891724167
  NPD (past)

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1366690257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 MEDICAL ARTS BLVD",
            "address_2": "SUITE 217",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113439",
            "telephone_number": "765-298-4422",
            "fax_number": "765-298-4926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 MEDICAL ARTS BLVD",
            "address_2": "SUITE 217",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113439",
            "telephone_number": "765-298-4422",
            "fax_number": "765-298-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JETTY HEART CLINIC OF THE INDIANA HEART HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-04",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "MALASTO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "317-621-8050"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01040154A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000586511",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Randall Jennings, MD
• Eunmi Wang Jeong, OTA
• Joseph G. Jerman, MD
• Jerry D Warthman, O.D., LLC
• Jetty Heart Clinic
• Preetham Jetty, MD
• Audre N Johnson, NP
• Grace Rebekah Johnson
• Greg Johnson, LSW
• Heidi Ann Johnson, MD

• Cardiovascular Disease Physician in Anderson, IN
• Providers in Anderson, IN by specialty
• Cardiovascular Disease Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.