Active NPI
Robert D Deitch, MD
- Ophthalmology Physician
- Indianapolis, IN
National Provider Identifier
1578522850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 01033749
- Practice address
- 10300 N Illinois St
Suite 1040
Indianapolis, IN 46290-1166 - Phone
- (317) 817-1765
- Fax
- (317) 817-1767
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 01033749 | IN | Primary |
Addresses
Primary practice location
10300 N Illinois St
Suite 1040
Indianapolis, IN 46290-1166
Mailing address
10300 N Illinois St
Suite 1040
Indianapolis, IN 46290-1166
Phone (317) 817-1765
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100068910C | Medicaid | IN |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01033749 | IN | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Ophthalmology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483833600000",
"number": "1578522850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10300 N ILLINOIS ST",
"address_2": "SUITE 1040",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462901166",
"telephone_number": "317-817-1765",
"fax_number": "317-817-1767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10300 N ILLINOIS ST",
"address_2": "SUITE 1040",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462901166",
"telephone_number": "317-817-1765",
"fax_number": "317-817-1767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITCH",
"first_name": "ROBERT",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2017-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "01033749",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100068910C",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.