NPIMap

Organization Active NPI

Emerald Neuro-Recover

  • Family Medicine Physician
  • Carmel, IN
National Provider Identifier
1508334814
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EMERALD NEURO-RECOVER
Practice address
12265 Hancock St Ste 42
Carmel, IN 46032-5801
Phone
(317) 606-8778
Fax
(317) 740-0534
NPI assigned
Nov 5, 2018
Last updated
Sep 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
Margaret G Dunteman, CREDENTIALING DEPT.
Title
Billing Agent
Phone
(630) 770-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

12265 Hancock St Ste 42
Carmel, IN 46032-5801

Mailing address

12265 Hancock St Ste 42
Carmel, IN 46032-5801
Phone (317) 606-8778

Other identifiers 4

IdentifierTypeStateIssuer
000000380603OtherINANTHEM
2617421MedicaidOH
200216290MedicaidIN
104874712MedicaidMI

National Provider Directory

National Provider Directory

Locations

12265 Hancock St
Ste 42
Carmel, IN 46032
Phone (317) 606-8778

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1508334814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12265 HANCOCK ST STE 42",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325801",
            "telephone_number": "317-606-8778",
            "fax_number": "317-740-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12265 HANCOCK ST STE 42",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325801",
            "telephone_number": "317-606-8778",
            "fax_number": "317-740-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD NEURO-RECOVER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-05",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "DUNTEMAN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "630-770-3800",
        "authorized_official_credential": "CREDENTIALING DEPT."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000380603",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2617421",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200216290",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104874712",
            "state": "MI"
        }
    ],
    "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 Sep 25, 2019; 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.