NPIMap

Organization Active NPI

St Clare Medical Center

  • Family Medicine Physician
  • Crawfordsville, IN
National Provider Identifier
1417021817
Registry record updated Jul 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST CLARE MEDICAL CENTER
Practice address
407 E Market St
Crawfordsville, IN 47933-1852
Phone
(765) 364-4424
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2008

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

Authorized official

Name
Jim Siemers
Title
Executive Director
Phone
(765) 362-2800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

407 E Market St
Crawfordsville, IN 47933-1852

Mailing address

1710 Lafayette Rd
Crawfordsville, IN 47933-1033
Phone (765) 362-2800

Other identifiers 1

IdentifierTypeStateIssuer
200264430AMedicaidIN

Other names 1

  • St Clare Neighborhood Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Clare Medical Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1417021817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 LAFAYETTE RD",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331033",
            "telephone_number": "765-362-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E MARKET ST",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331852",
            "telephone_number": "765-364-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLARE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "SIEMERS",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "765-362-2800"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200264430A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Clare Neighborhood Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crawfordsville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; 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.