Active NPI
Gary W Misamore, MD
- Sports Medicine (Orthopaedic Surgery) Physician
- Indianapolis, IN
National Provider Identifier
1659324416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician
- License
- 01028154A
- Practice address
- 201 Pennsylvania Parkway
Suite 200
Indianapolis, IN 46280-2301 - Phone
- (317) 817-1200
- Fax
- (317) 208-1551
- NPI assigned
- May 19, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 01028154A | IN | Primary |
Addresses
Primary practice location
201 Pennsylvania Parkway
Suite 200
Indianapolis, IN 46280-2301
Mailing address
201 Pennsylvania Parkway
Suite 200
Indianapolis, IN 46280-2301
Phone (317) 817-1200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100461060 | Medicaid | IN | |
| 200013396 | Other | IN | RR MEDICARE |
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 |
|---|---|---|---|
| 01028154A | IN | MD | Sports Medicine (Orthopaedic Surgery) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | 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.
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426118400000",
"number": "1659324416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 PENNSYLVANIA PARKWAY",
"address_2": "SUITE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462802301",
"telephone_number": "317-817-1200",
"fax_number": "317-208-1551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 PENNSYLVANIA PARKWAY",
"address_2": "SUITE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462802301",
"telephone_number": "317-817-1200",
"fax_number": "317-208-1551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISAMORE",
"first_name": "GARY",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2015-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "207XX0005X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "IN",
"license": "01028154A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100461060",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "200013396",
"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 Mar 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.