Organization Active NPI

Indiana University Health North Hospital, Inc

  • Surgery Physician
  • Carmel, IN
National Provider Identifier
1396765731
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC
Practice address
11725 N Illinois St
Carmel, IN 46032-3008
Phone
(317) 962-4836
Fax
(317) 962-4391
NPI assigned
Jul 20, 2006
Last updated
Nov 4, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
INDIANA UNIVERSITY HEALTH, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
Jonathan R Goble
Title
President, Ceo
Phone
(317) 962-4836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X IN Primary

Addresses

Primary practice location

11725 N Illinois St
Carmel, IN 46032-3008

Mailing address

250 N Shadeland Ave
Suite 130
Indianapolis, IN 46219-4959
Phone (317) 962-4836

Other identifiers 1

IdentifierTypeStateIssuer
200815390AMedicaidIN

Other names 1

  • Clarian Health North LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120702000235 IN Part B Supplier - Clinic/Group Practice 2860452505 Receives reassigned benefits from 12 practitioners
Practice locations: Carmel, IN

National Provider Directory

National Provider Directory
Part of
Clinical Laboratory SVC

Locations

2854 Reliable Pkwy
Chicago, IL 60686

2854 Reliable Pkwy
#862854
Chicago, IL 60686

250 N Shadeland Ave
Ste 130
Indianapolis, IN 46219
Phone (317) 962-4836

Practitioners & affiliated clinicians

Practitioners 92

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.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1396765731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "SUITE 130",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959",
            "telephone_number": "317-962-4836",
            "fax_number": "317-962-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11725 N ILLINOIS ST",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323008",
            "telephone_number": "317-962-4836",
            "fax_number": "317-962-4391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIANA UNIVERSITY HEALTH, INC",
        "enumeration_date": "2006-07-20",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "GOBLE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "317-962-4836"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200815390A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarian Health North LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Carmel, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.