NPIMap

Organization Active NPI

Northside Gastroenterology Endoscopy Center LLC

Doing business as Northside Gastroenterology Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Indianapolis, IN
National Provider Identifier
1659344133
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
05-008902 Issued in IN
Legal business name
NORTHSIDE GASTROENTEROLOGY ENDOSCOPY CENTER LLC
Doing business as
Northside Gastroenterology Endoscopy Center
Practice address
8424 Naab Rd
Suite 3-G
Indianapolis, IN 46260-5918
Phone
(317) 871-7308
Fax
(317) 871-7314
NPI assigned
Feb 7, 2006
Last updated
Apr 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Authorized official

Name
Mr. Jeffrey Snodgrass
Title
President
Phone
(615) 665-1283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 05-008902 IN Primary

Addresses

Primary practice location

8424 Naab Rd
Suite 3-G
Indianapolis, IN 46260-5918

Mailing address

1A Burton Hills Blvd
Attn: L&C
Nashville, TN 37215-6103
Phone (317) 871-7308

Other identifiers 2

IdentifierTypeStateIssuer
490003884OtherINRAILROAD MEDICARE
200119350AMedicaidIN

Other names 1

  • Northside Gastroenterology Endoscopy Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050603000702 IN Part B Supplier - Ambulatory Surgical Center 4082657713 Practice locations: Indianapolis, IN

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Northside Gastroenterology Endoscopy CenterCCN 15C0001062
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1659344133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD",
            "address_2": "ATTN: L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156103",
            "telephone_number": "317-871-7308",
            "fax_number": "317-871-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8424 NAAB RD",
            "address_2": "SUITE 3-G",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605918",
            "telephone_number": "317-871-7308",
            "fax_number": "317-871-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE GASTROENTEROLOGY ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "05-008902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490003884",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200119350A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Gastroenterology Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northside Gastroenterology Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.