NPIMap

Individual provider Active NPI

Brenda B Jurich, MD

  • Diagnostic Radiology Physician
  • Lafayette, IN
National Provider Identifier
1376512327
Registry record updated Mar 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01033781A Issued in IN
Practice address
1701 S Creasy LN
Lafayette, IN 47905-4972
Phone
(765) 446-4819
Fax
(765) 446-4859
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2011

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 01033781A IN Primary

Addresses

Primary practice location

1701 S Creasy LN
Lafayette, IN 47905-4972

Mailing address

3900 St Francis Way
Suite 215
Lafayette, IN 47905-4923
Phone (765) 446-4819

Other identifiers 3

IdentifierTypeStateIssuer
000000524004OtherINANTHEM
200041260MedicaidIN
P00414329OtherINMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01033781AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Solis Women's Health Breast Imaging Specialists of Indiana, PC Past Accepting new patients
Indianapolis Breast Center, PC Diagnostic Radiology Past Accepting new patients
Unity Healthcare LLC Past Accepting new patients
Nufinity, LLC Diagnostic Radiology Past Accepting new patients

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299024000000",
    "number": "1376512327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 ST FRANCIS WAY",
            "address_2": "SUITE 215",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054923",
            "telephone_number": "765-446-4819",
            "fax_number": "765-446-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 S CREASY LN",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054972",
            "telephone_number": "765-446-4819",
            "fax_number": "765-446-4859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURICH",
        "first_name": "BRENDA",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2011-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01033781A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000524004",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200041260",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00414329",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; 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.