NPIMap

Organization Active NPI

Midwest Ear Nose and Throat Surgery, PSC

  • Otolaryngology Physician
  • Evansville, IN
National Provider Identifier
1437153285
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MIDWEST EAR NOSE AND THROAT SURGERY, PSC
Practice address
1401 Professional Blvd
Evansville, IN 47714-8014
Phone
(812) 473-2060
Fax
(812) 473-0763
NPI assigned
Jun 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Authorized official

Name
Jessica Denton
Title
Credentialing Rep
Phone
(812) 473-2060

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0905X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

1401 Professional Blvd
Evansville, IN 47714-8014

Mailing address

1401 Professional Blvd
Evansville, IN 47714-8014
Phone (812) 473-2060

Other identifiers 3

IdentifierTypeStateIssuer
200069270AMedicaidIN
200069270DMedicaidIN
65937542MedicaidKY

Other names 1

  • Midwest Otolarngology Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407001131 KY Part B Supplier - Clinic/Group Practice 3173516887 Receives reassigned benefits from 8 practitioners
Practice locations: Henderson, KY
O20060124000726 IN Part B Supplier - Clinic/Group Practice 3173516887 Receives reassigned benefits from 15 practitioners
Practice locations: Evansville, IN

National Provider Directory

National Provider Directory

Locations

1020 Professional Blvd
Evansville, IN 47714
Phone (812) 473-2060

1401 Professional Blvd
Evansville, IN 47714
Phone (812) 469-3706

607 Dubois St
Vincennes, IN 47591
Phone (812) 473-2060

605 Dubois St
Vincennes, IN 47591

1305 N Elm St
Ste 110
Henderson, KY 42420
Phone (270) 827-2312

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1437153285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 PROFESSIONAL BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148014",
            "telephone_number": "812-473-2060",
            "fax_number": "812-473-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 PROFESSIONAL BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148014",
            "telephone_number": "812-473-2060",
            "fax_number": "812-473-0763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST EAR NOSE AND THROAT SURGERY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "DENTON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING REP",
        "authorized_official_telephone_number": "812-473-2060"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200069270A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200069270D",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65937542",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Otolarngology",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Midwest Otolarngology",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.