NPIMap

Organization Active NPI

Saint John's Health System

Doing business as Pendleton Family Practice Center

  • Family Medicine Physician
  • Pendleton, IN
National Provider Identifier
1487760849
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAINT JOHN'S HEALTH SYSTEM
Doing business as
Pendleton Family Practice Center
Practice address
75 Village Dr
Pendleton, IN 46064-8960
Phone
(765) 778-0913
Fax
(765) 778-1374
NPI assigned
Aug 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
James W Moore
Title
Executive Vice President
Phone
(765) 646-8105

Specialties & licenses 1

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

Addresses

Primary practice location

75 Village Dr
Pendleton, IN 46064-8960

Mailing address

75 Village Dr
Pendleton, IN 46064-8960
Phone (765) 778-0913

Other names 1

  • Pendleton Family Practice Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Vincent Madison County7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487760849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 VILLAGE DR",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "460648960",
            "telephone_number": "765-778-0913",
            "fax_number": "765-778-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 VILLAGE DR",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "460648960",
            "telephone_number": "765-778-0913",
            "fax_number": "765-778-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOHN'S HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "765-646-8105"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pendleton Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pendleton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.