NPIMap

Organization Active NPI

Personalized Healthcare of Carmel, LLC

  • Family Medicine Physician
  • Carmel, IN
National Provider Identifier
1477889285
Registry record updated Oct 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01034557A Issued in IN
Legal business name
PERSONALIZED HEALTHCARE OF CARMEL, LLC
Practice address
11900 N Pennsylvania St
Suite 200
Carmel, IN 46032-4693
Phone
(317) 663-7123
Fax
(317) 663-7123
NPI assigned
Oct 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2009

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

Authorized official

Name
Dr. Clifford W Fetters, MD
Title
President
Phone
(317) 663-7128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 01034557A IN Primary

Addresses

Primary practice location

11900 N Pennsylvania St
Suite 200
Carmel, IN 46032-4693

Mailing address

11900 N Pennsylvania St
Suite 200
Carmel, IN 46032-4693
Phone (317) 663-7123

National Provider Directory

National Provider Directory

Locations

11900 Pennsylvania St
Ste 200
Carmel, IN 46032
Phone (317) 663-7123

NPI Registry JSON

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

{
    "created_epoch": "1256774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256774400000",
    "number": "1477889285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 N PENNSYLVANIA ST",
            "address_2": "SUITE 200",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324693",
            "telephone_number": "317-663-7123",
            "fax_number": "317-663-7123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 N PENNSYLVANIA ST",
            "address_2": "SUITE 200",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324693",
            "telephone_number": "317-663-7123",
            "fax_number": "317-663-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED HEALTHCARE OF CARMEL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-29",
        "last_updated": "2009-10-29",
        "status": "A",
        "authorized_official_last_name": "FETTERS",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-663-7128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01034557A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2009; 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.