Active NPI
Allied Physicians of Michiana, LLC
Doing business as Allied ENT Specialty Center
- Specialist
- South Bend, IN
National Provider Identifier
1366777369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- ALLIED PHYSICIANS OF MICHIANA, LLC
- Doing business as
- Allied ENT Specialty Center
- Practice address
- 6301 University Commons
Suite 360
South Bend, IN 46635-1571 - Phone
- (574) 232-4800
- Fax
- (574) 280-4810
- NPI assigned
- Oct 8, 2009
- Last updated
- Oct 2, 2015
- Organization subpart
- Yes
- Parent organization
- ALLIED PHYSICIANS OF MICHIANA, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shery A. Roussarie
- Title
- Ceo
- Phone
- (574) 251-2100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
6301 University Commons
Suite 360
South Bend, IN 46635-1571
Mailing address
6301 University Commons
Suite 230
South Bend, IN 46635-1571
Phone (574) 251-2100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200962980F | Medicaid | IN | |
| 200962980P | Medicaid | IN |
Other names 1
- Allied ENT Specialty Center
National Provider Directory
National Provider Directory- Part of
- Allied Physicians of Michiana LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254960000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1443744000000",
"number": "1366777369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6301 UNIVERSITY COMMONS",
"address_2": "SUITE 230",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351571",
"telephone_number": "574-251-2100",
"fax_number": "574-251-2151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6301 UNIVERSITY COMMONS",
"address_2": "SUITE 360",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351571",
"telephone_number": "574-232-4800",
"fax_number": "574-280-4810"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALLIED PHYSICIANS OF MICHIANA, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ALLIED PHYSICIANS OF MICHIANA, LLC",
"enumeration_date": "2009-10-08",
"last_updated": "2015-10-02",
"status": "A",
"authorized_official_last_name": "ROUSSARIE",
"authorized_official_first_name": "SHERY",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "574-251-2100"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200962980F",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200962980P",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Allied ENT Specialty Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in South Bend, IN
- Allied Physicians of Michiana, LLC (Allied Bone and joint)
- Allied Physicians of Michiana, LLC (Pediatric Associates of Michiana)
- Allied Physicians of Michiana, LLC
- Allied Physicians of Michiana, LLC (Allied Bone and Joint)
- Allied Physicians of Michiana, LLC (Northern IN Hand & Wrist)
- Allied Physicians of Michiana, LLC (General & Vascular Surgery)
- Allied Physicians of Michiana, LLC (Northern Indiana Center for Pelvic Health & Gynecology)
- Allied Physicians of Michiana, LLC (Urology Associates of South Bend)
- Allied Physicians of Michiana, LLC (Michiana Ob/GYN)
- Allied Physicians of Michiana, LLC (OB Gyn Associates of Northern IN)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.