NPIMap

Individual provider Active NPI

Opkardeep Tut

  • Surgical Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1407398266
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10002156A Issued in IN
Practice address
6470 N Shadeland Ave Ste D
Indianapolis, IN 46220-4386
Phone
(317) 598-0094
Fax
(317) 468-9202
NPI assigned
Nov 10, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 53853 CA
Surgical Physician Assistant 363AS0400X 10002156A IN Primary

Addresses

Primary practice location

6470 N Shadeland Ave Ste D
Indianapolis, IN 46220-4386

Mailing address

6470 N Shadeland Ave Ste D
Indianapolis, IN 46220-4386
Phone (317) 598-0094

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210517002490 CA Practitioner - Physician Assistant 4284995705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical Group 11,250 clinicians

Practice addresses (Care Compare)

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53853CAMDPhysician Assistant
10002156AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Feb 10, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 10, 2021 Accepting new patients
Advanced Surgery of Indiana LLC Past Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 7

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": "1478736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1407398266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6470 N SHADELAND AVE STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204386",
            "telephone_number": "317-598-0094",
            "fax_number": "317-468-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6470 N SHADELAND AVE STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204386",
            "telephone_number": "317-598-0094",
            "fax_number": "317-468-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUT",
        "first_name": "OPKARDEEP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-10",
        "last_updated": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53853",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10002156A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.