Adolph Ralph Yaniz, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

010380025A Issued in IN

Practice address

5490 Broadway
Suite 105
Merrillville, IN 46410-1675

Phone

(219) 884-3210

Fax

(219) 884-3244

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268956800000",
    "number": "1639229156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5490 BROADWAY",
            "address_2": "SUITE 105",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464101675",
            "telephone_number": "219-884-3210",
            "fax_number": "219-884-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5490 BROADWAY",
            "address_2": "SUITE 105",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464101675",
            "telephone_number": "219-884-3210",
            "fax_number": "219-884-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANIZ",
        "first_name": "ADOLPH",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2010-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "010380025A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000088069",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100201270A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Qun Wu, MD, MB
• Kiayana Wynn
• Karen M Wyss, P.T.
• Bruce R Yalowitz, MD
• Maisee Yang, BA, RBT
• Calvin Butler Yates, O.D.
• Leon A Yeh, MD
• Yeretsian Medical Corporation
• Brittany Ann Young
• Destiny Andrea Young

• Family Medicine Physician in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.