Organization Active NPI

Medical Specialists of Madison County, PC

  • Pulmonary Disease Physician
  • Anderson, IN
National Provider Identifier
1508891664
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
MEDICAL SPECIALISTS OF MADISON COUNTY, PC
Practice address
2101 Jackson St Ste 110
Anderson, IN 46016-4386
Phone
(765) 643-6012
Fax
(765) 646-9054
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Authorized official

Name
David C Mares, MDNPI 1396770335
Title
President
Phone
(765) 643-6012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X

Addresses

Primary practice location

2101 Jackson St Ste 110
Anderson, IN 46016-4386

Mailing address

2101 Jackson St
Suite 110
Anderson, IN 46016-4386
Phone (765) 643-6012

Other identifiers 1

IdentifierTypeStateIssuer
200322260AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050416000059 IN Part B Supplier - Clinic/Group Practice 8729025168 Receives reassigned benefits from 4 practitioners
Practice locations: Anderson, IN; Elwood, IN

National Provider Directory

National Provider Directory

Locations

2101 Jackson St
Ste 110
Anderson, IN 46016
Phone (765) 643-6012

3631 N Morrison Rd
#200
Muncie, IN 47304
Phone (765) 281-3443

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1508891664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 JACKSON ST",
            "address_2": "SUITE 110",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164386",
            "telephone_number": "765-643-6012",
            "fax_number": "765-646-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 JACKSON ST STE 110",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164386",
            "telephone_number": "765-643-6012",
            "fax_number": "765-646-9054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SPECIALISTS OF MADISON COUNTY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "MARES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-643-6012",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200322260A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.