NPIMap

Organization Active NPI

Saint John's Health System

Doing business as Children's Clinic

  • Pediatrics Physician
  • Anderson, IN
National Provider Identifier
1417065764
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SAINT JOHN'S HEALTH SYSTEM
Doing business as
Children's Clinic
Practice address
15 W 19TH St
Anderson, IN 46016-4306
Phone
(765) 646-8299
Fax
(765) 646-8672
NPI assigned
Aug 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
James W Moore
Title
Executive Vice President
Phone
(765) 646-8105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

15 W 19TH St
Anderson, IN 46016-4306

Mailing address

15 W 19TH St
Anderson, IN 46016-4306
Phone (765) 646-8299

Other names 1

  • Children's Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Vincent Madison County7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

15 W 19th St
Anderson, IN 46016
Phone (765) 646-8299

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417065764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 W 19TH ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164306",
            "telephone_number": "765-646-8299",
            "fax_number": "765-646-8672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 W 19TH ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164306",
            "telephone_number": "765-646-8299",
            "fax_number": "765-646-8672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOHN'S HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "765-646-8105"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anderson, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.