Pediatric Rehabilitation of Indiana, Inc

Primary specialty

Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X

License

01043182A Issued in IN

Legal business name

PEDIATRIC REHABILITATION OF INDIANA, INC

Practice address

3825 N Meridian St
Indianapolis, IN 46208-4018

Phone

(361) 548-5270

NPI assigned

May 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Susan Caldecott Dieterich, MD

Title

Owner

Phone

(361) 548-5270

Specialties & licenses 1

Addresses

Practitioners 1

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

• Susan Caldecott-Johnson, MD

  • Pediatric Rehabilitation Medicine Physician
  • Indianapolis, IN
  • NPI 1902999055
  NPD

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

{
    "created_epoch": "1179619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629286794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5006 DEER PARK CIR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784136027",
            "telephone_number": "361-548-5270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 N MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084018",
            "telephone_number": "361-548-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC REHABILITATION OF INDIANA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIETERICH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "CALDECOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "361-548-5270",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "IN",
            "license": "01043182A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Anne Pederson, PHD
• Pediatric Dentistry North
• Pediatric Dentistry West, LLC
• Pediatric Neuropsychology Associates
• Pediatric Nursing Specialists of Indiana, Inc. (Deaconess HomeCare)
• Pediatric Specialty Associates, Inc
• Pediatric Specialty Associates, Inc
• Pediatric Surgical Associates Inc
• Pediplay LLC
• Peds Psychiatry LLC

• Pediatric Rehabilitation Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Pediatric Rehabilitation Medicine Physician in Indiana

• 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.