NPIMap

Organization Active NPI

My Mobile MD Northern Indiana

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1629623913
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MY MOBILE MD NORTHERN INDIANA
Practice address
429 E Vermont St Ste 110
Indianapolis, IN 46202-3685
Phone
(317) 559-0950
Fax
(317) 936-3028
NPI assigned
Aug 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Steve Martin, PARTNER
Title
Ceo
Phone
(317) 670-6635

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

429 E Vermont St Ste 110
Indianapolis, IN 46202-3685

Mailing address

PO Box 305
Union City, IN 47390-0305
Phone (765) 969-7841

National Provider Directory

National Provider Directory

Locations

2600 Western Ave
Connersville, IN 47331
Phone (765) 825-6800

1719 Columbia Ave
Connersville, IN 47331

Practitioners & affiliated clinicians

Practitioners 1

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": "1564963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1629623913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "UNION CITY",
            "state": "IN",
            "postal_code": "473900305",
            "telephone_number": "765-969-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 E VERMONT ST STE 110",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023685",
            "telephone_number": "317-559-0950",
            "fax_number": "317-936-3028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY MOBILE MD NORTHERN INDIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-05",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "317-670-6635",
        "authorized_official_credential": "PARTNER"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 21, 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.