Active NPI
Allan O Diefendorf, PH.D.
- Audiologist
- Indianapolis, IN
National Provider Identifier
1447484464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 23001934
- Practice address
- 702 Barnhill Dr
Suite 0860
Indianapolis, IN 46202-5128 - Phone
- (317) 630-8970
- Fax
- (317) 630-8958
- NPI assigned
- May 5, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 23001934 | IN | Primary |
Addresses
Primary practice location
702 Barnhill Dr
Suite 0860
Indianapolis, IN 46202-5128
Mailing address
250 N Shadeland Ave
Ste 130 Provider Enrollment
Indianapolis, IN 46219-4959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23001934 | Other | IN | 0000000000 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23001934 | IN | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| General Otorhinolaryngological Foundation, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Otolaryngology Physician
- Indianapolis, IN
- NPI 1992715452
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390953600000",
"number": "1447484464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"address_2": "STE 130 PROVIDER ENROLLMENT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 BARNHILL DR",
"address_2": "SUITE 0860",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025128",
"telephone_number": "317-630-8970",
"fax_number": "317-630-8958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEFENDORF",
"first_name": "ALLAN",
"middle_name": "O",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-05",
"last_updated": "2014-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IN",
"license": "23001934",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "0000000000",
"identifier": "23001934",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.