Active NPI
Monica Prasad Gibson, BDS, PHD, MS, FRCDC
- Periodontics
- Indianapolis, IN
National Provider Identifier
1467885756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12014259A
- Practice address
- 1121 W Michigan St
Indianapolis, IN 46202-5211 - Phone
- (317) 274-5122
- NPI assigned
- Aug 9, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 12014259A | IN | Primary |
Addresses
Primary practice location
1121 W Michigan St
Indianapolis, IN 46202-5211
Mailing address
1121 W Michigan St # 423
Indianapolis, IN 46202-5211
Phone (317) 274-5122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230705001847 | IN | Order and Referring Only - Dentist | 4284093584 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12014259A | IN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705708800000",
"number": "1467885756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 W MICHIGAN ST # 423",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025211",
"telephone_number": "317-274-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1121 W MICHIGAN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025211",
"telephone_number": "317-274-5122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "MONICA",
"middle_name": "PRASAD",
"name_prefix": "Dr.",
"credential": "BDS, PHD, MS, FRCDC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-09",
"last_updated": "2024-01-20",
"certification_date": "2024-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "12014259A",
"primary": true
}
],
"identifiers": [],
"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 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.