Active NPI
Innovative Medicine
- Addiction Medicine (Family Medicine) Physician
- Lafayette, IN
National Provider Identifier
1417486523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Family Medicine) Physician
- Legal business name
- INNOVATIVE MEDICINE
- Practice address
- 3554 Promenade Pkwy Ste H
Lafayette, IN 47909-8418 - Phone
- (765) 471-1100
- Fax
- (765) 471-1009
- NPI assigned
- Jun 12, 2017
- Last updated
- Apr 18, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jacqueline Snyder
- Title
- Billing Manager
- Phone
- (765) 413-7100
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Family Medicine) Physician | 207QA0401X | Primary | ||
| Adult Medicine Physician | 207QA0505X | |||
| Obesity Medicine (Family Medicine) Physician | 207QB0002X | |||
| Non-Pharmacy Dispensing Site | 332900000X |
Addresses
Primary practice location
3554 Promenade Pkwy Ste H
Lafayette, IN 47909-8418
Mailing address
3554 Promenade Pkwy Ste H
Lafayette, IN 47909-8418
Phone (765) 471-1100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144372863 | Other | IN | ROBERT CHARLES TURNER MD |
| 1720219702 | Other | IN | MELISSA GALBRETH LMHC |
National Provider Directory
National Provider DirectoryLocations
3554 Promenade Pkwy
Ste H
Lafayette, IN 47909
Phone (765) 471-1100
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Adult Medicine Physician
- Lafayette, IN
- NPI 1144372863
Addiction Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1713398400000",
"number": "1417486523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3554 PROMENADE PKWY STE H",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479098418",
"telephone_number": "765-471-1100",
"fax_number": "765-471-1009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3554 PROMENADE PKWY STE H",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479098418",
"telephone_number": "765-471-1100",
"fax_number": "765-471-1009"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOVATIVE MEDICINE",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-12",
"last_updated": "2024-04-18",
"certification_date": "2024-04-18",
"status": "A",
"authorized_official_last_name": "SNYDER",
"authorized_official_first_name": "JACQUELINE",
"authorized_official_title_or_position": "BILLING MANAGER",
"authorized_official_telephone_number": "765-413-7100"
},
"taxonomies": [
{
"code": "207QA0401X",
"taxonomy_group": "",
"desc": "Family Medicine, Addiction Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207QB0002X",
"taxonomy_group": "",
"desc": "Family Medicine, Obesity Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "332900000X",
"taxonomy_group": "",
"desc": "Non-Pharmacy Dispensing Site",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ROBERT CHARLES TURNER MD",
"identifier": "1144372863",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MELISSA GALBRETH LMHC",
"identifier": "1720219702",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Lafayette, IN
- Inner Peace Therapy LLC
- Innervision Advanced Medical Imaging Center, LLC
- Innerwaves Massage Therapy
- Innisfree Counseling LLC
- Innovative Hearing Solutions of Indiana, Inc (Hearing Solutions of Indiana)
- Institutional Pharmacy Solutions LLC (Institutional Pharmacy Solutions)
- Integrity Care LLC
- Irons, Inc, (Home Instead Senior Care)
- Amber Irvin
- Hannah Isler, MD RD CD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.