Organization Active NPI

Innovative Medicine

  • Addiction Medicine (Family Medicine) Physician
  • Lafayette, IN
National Provider Identifier
1417486523
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
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, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
1144372863OtherINROBERT CHARLES TURNER MD
1720219702OtherINMELISSA GALBRETH LMHC

National Provider Directory

National Provider Directory

Locations

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.

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

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.

Verify at the official NPI Registry.