Bloomington Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

05-002674-1 Issued in IN

Legal business name

BLOOMINGTON ENDOSCOPY CENTER, LLC

Practice address

550 S Landmark Ave
Bloomington, IN 47403-3239

Phone

(812) 331-3650

Fax

(812) 355-6925

NPI assigned

Jun 16, 2005

Last updated

Dec 7, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Craig

Title

Cfo

Phone

(812) 353-9554

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Bloomington Endoscopy CenterCCN 15C0001101

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Indiana University Health Bloomington Inc

  dba Iu Health Bloomington

  • General Acute Care Hospital
  • Bloomington, IN
  • NPI 1205860335

  Member Of

  NPD member
• Premier Healthcare, LLC

  • Sports Medicine (Family Medicine) Physician
  • Bloomington, IN
  • NPI 1659684462

  Member Of

  NPD member

Practitioners 1

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.

• Hojjat Shamloo, MD

  • Internal Medicine Physician
  • Bedford, IN
  • NPI 1578557245
  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544140800000",
    "number": "1689679508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-331-3650",
            "fax_number": "812-355-6925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-331-3650",
            "fax_number": "812-355-6925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2018-12-07",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-353-9554"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "05-002674-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200319120",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloomington Counseling Center
• Bloomington Dental Group
• Bloomington Dermatology Clinic
• Bloomington Emergency Care LLC
• Bloomington Emergency Group PC
• Bloomington ENT PC
• Bloomington Eye Care PC
• Bloomington Family Dental
• Bloomington Fire Department
• Bloomington Kidney & Hypertension Specialists PC

• Ambulatory Surgical Clinic/Center in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; 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.