NPIMap

Organization Active NPI

Indiana University Health Ball Memorial Physicians, Inc.

Doing business as IU Health Ball Memorial Physicians

  • Developmental - Behavioral Pediatrics Physician
  • Muncie, IN
National Provider Identifier
1679893580
Registry record updated Oct 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Doing business as
IU Health Ball Memorial Physicians
Practice address
205 N Tillotson Ave
Suite 102
Muncie, IN 47304-3990
Phone
(765) 751-3173
Fax
(765) 213-2592
NPI assigned
Jun 3, 2010
Last updated
Oct 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2013

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

Authorized official

Name
Janet L Vangets
Title
Director/Officer
Phone
(765) 751-5404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics Physician 2080P0006X NU Primary

Addresses

Primary practice location

205 N Tillotson Ave
Suite 102
Muncie, IN 47304-3990

Mailing address

250 N Shadeland Ave
Attn: Carol Boyd
Indianapolis, IN 46219-4959
Phone (317) 963-0413

Other identifiers 1

IdentifierTypeStateIssuer
200986050 DMedicaidIN

Other names 1

  • IU Health Ball Memorial Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000505 IN Part B Supplier - Clinic/Group Practice 9537072640 Receives reassigned benefits from 661 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Indiana University Phy Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

205 N Tillotson Ave
Ste 102
Muncie, IN 47304
Phone (765) 751-3173

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381708800000",
    "number": "1679893580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "ATTN: CAROL BOYD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959",
            "telephone_number": "317-963-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N TILLOTSON AVE",
            "address_2": "SUITE 102",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473043990",
            "telephone_number": "765-751-3173",
            "fax_number": "765-213-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-03",
        "last_updated": "2013-10-14",
        "status": "A",
        "authorized_official_last_name": "VANGETS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR/OFFICER",
        "authorized_official_telephone_number": "765-751-5404"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200986050 D",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IU Health Ball Memorial Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muncie, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.