Active NPI
Ian Melton, BCBA
- Behavior Analyst
- South Bend, IN
National Provider Identifier
1376947713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 2012 Ironwood Circle
Suite 100
South Bend, IN 46635-1889 - Phone
- (855) 324-0885
- Fax
- (765) 450-6664
- NPI assigned
- Oct 14, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-14-10035 | MA | |
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
2012 Ironwood Circle
Suite 100
South Bend, IN 46635-1889
Mailing address
700 E Firmin Street
Suite 209
Kokomo, IN 46902-2375
Phone (765) 454-9748
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-14-10035 | Other | BCBA CERTIFICATE |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Journeys Behavior Learning Center LLC | Past | Accepting new patients | |
| Hopebridge, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Developmental Disabilities Clinic/Center
- Mishawaka, IN
- NPI 1467924324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448928000000",
"number": "1376947713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 E FIRMIN STREET",
"address_2": "SUITE 209",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469022375",
"telephone_number": "765-454-9748",
"fax_number": "765-450-6664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 IRONWOOD CIRCLE",
"address_2": "SUITE 100",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351889",
"telephone_number": "855-324-0885",
"fax_number": "765-450-6664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELTON",
"first_name": "IAN",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-14",
"last_updated": "2015-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "1-14-10035",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBA CERTIFICATE",
"identifier": "1-14-10035",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.