NPIMap

Organization Active NPI

Clown Pediatrics

  • Specialist
  • Greenwood, IN
National Provider Identifier
1669674461
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1057187 A Issued in IN
Legal business name
CLOWN PEDIATRICS
Practice address
401 Camby CT
Greenwood, IN 46142-4085
Phone
(317) 881-8737
Fax
(317) 881-8735
NPI assigned
Jun 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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

Authorized official

Name
Jeremy Wade Roscoe, M.D.NPI 1386620961
Title
Physician
Phone
(317) 881-8737

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 1057187 A IN Primary

Addresses

Primary practice location

401 Camby CT
Greenwood, IN 46142-4085

Mailing address

401 Camby CT
Greenwood, IN 46142-4085
Phone (317) 881-8737

Other identifiers 1

IdentifierTypeStateIssuer
200479420 AMedicaidIN

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
15D1029507Clown Pediatrics PC401 Camby CT, Greenwood, IN 46142Certificate of waiverAug 17, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCBAAA

Practitioners & affiliated clinicians

Practitioners 9

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": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304899200000",
    "number": "1669674461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CAMBY CT",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461424085",
            "telephone_number": "317-881-8737",
            "fax_number": "317-881-8735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CAMBY CT",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461424085",
            "telephone_number": "317-881-8737",
            "fax_number": "317-881-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOWN PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2011-05-09",
        "status": "A",
        "authorized_official_last_name": "ROSCOE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "317-881-8737",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "1057187 A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200479420 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.