Active NPI
Amy M Bobalik, R.D.
- Registered Dietitian
- Pierceton, IN
National Provider Identifier
1497060511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 37001977A
- Practice address
- 5 Matchett Dr
US Hwy 30 W
Pierceton, IN 46562-9073 - Phone
- (574) 594-2136
- Fax
- (574) 594-2281
- NPI assigned
- Aug 12, 2010
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 37001977A | IN | Primary |
Addresses
Primary practice location
5 Matchett Dr
US Hwy 30 W
Pierceton, IN 46562-9073
Mailing address
1234 E Dupont Rd
Suite 1
Fort Wayne, IN 46825-1545
Phone (260) 373-9700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000675220 | Other | IN | ANTHEM |
| 000000675210 | Other | IN | ANTHEM |
| 000000675021 | Other | IN | ANTHEM |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37001977A | IN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364169600000",
"number": "1497060511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 E DUPONT RD",
"address_2": "SUITE 1",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251545",
"telephone_number": "260-373-9700",
"fax_number": "260-373-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 MATCHETT DR",
"address_2": "US HWY 30 W",
"city": "PIERCETON",
"state": "IN",
"postal_code": "465629073",
"telephone_number": "574-594-2136",
"fax_number": "574-594-2281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOBALIK",
"first_name": "AMY",
"middle_name": "M",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-12",
"last_updated": "2013-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "37001977A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000675220",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000675210",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000675021",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pierceton, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.