NPIMap

Organization Active NPI

Indiana Neurology and Pain Center LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Indianapolis, IN
National Provider Identifier
1659890218
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X
License
01067436A Issued in IN
Legal business name
INDIANA NEUROLOGY AND PAIN CENTER LLC
Practice address
7301 N Shadeland Ave Ste 1a
Indianapolis, IN 46250-2877
Phone
(317) 939-6100
NPI assigned
Sep 14, 2017
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Samiullah Kundi, MDNPI 1932249323
Title
Sole Member
Phone
(317) 939-6100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P2900X 01067436A IN Primary

Addresses

Primary practice location

7301 N Shadeland Ave Ste 1a
Indianapolis, IN 46250-2877

Mailing address

7301 N Shadeland Ave Ste 1a
Indianapolis, IN 46250-2877
Phone (317) 939-6100

Other practice location 1

3850 Shore Dr Ste 203
Indianapolis, IN 46254-2610
Phone (317) 939-6100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171218003404 IN Part B Supplier - Clinic/Group Practice 5294001574 Receives reassigned benefits from 20 practitioners
Practice locations: Indianapolis, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2166097Indiana Neurology and Pain Center7301 N Shadeland Avenue #1a, Indianapolis, IN 46250ComplianceFeb 15, 2027

National Provider Directory

National Provider Directory

Locations

3850 Shore Dr
Ste 203
Indianapolis, IN 46254
Phone (317) 297-3774

7301 N Shadeland Ave
Ste A
Indianapolis, IN 46250
Phone (317) 939-6100

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1659890218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 N SHADELAND AVE STE 1A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502877",
            "telephone_number": "317-939-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 N SHADELAND AVE STE 1A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502877",
            "telephone_number": "317-939-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3850 Shore Dr Ste 203",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462542610",
            "country_code": "US",
            "telephone_number": "317-939-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIANA NEUROLOGY AND PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "KUNDI",
        "authorized_official_first_name": "SAMIULLAH",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "317-939-6100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "IN",
            "license": "01067436A",
            "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 Oct 10, 2023; 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.