NPIMap

Organization Active NPI

Bloomington Meadows GP -

  • Psychiatric Residential Treatment Facility
  • Bloomington, IN
National Provider Identifier
1417968595
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
278652298 Issued in IN
Legal business name
BLOOMINGTON MEADOWS GP -
Practice address
3600 N Prow Rd
Bloomington, IN 47404-1616
Phone
(812) 331-8000
Fax
(812) 331-8985
NPI assigned
Aug 11, 2006
Last updated
Jan 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2011

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

Authorized official

Name
Ms. Becky Nyberg
Title
Cfo
Phone
(812) 331-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 278652298 IN Primary

Addresses

Primary practice location

3600 N Prow Rd
Bloomington, IN 47404-1616

Mailing address

3600 N Prow Rd
Bloomington, IN 47404-1616
Phone (812) 331-8000

Other identifiers 1

IdentifierTypeStateIssuer
200457070AMedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
David Gilliam MD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1417968595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 N PROW RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474041616",
            "telephone_number": "812-331-8000",
            "fax_number": "812-331-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 N PROW RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474041616",
            "telephone_number": "812-331-8000",
            "fax_number": "812-331-8985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON MEADOWS GP -",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "NYBERG",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-331-8000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "IN",
            "license": "278652298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200457070A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; 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.