NPIMap

Organization Active NPI

Indiana University

Doing business as Indiana University School of Dentistry

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1689790552
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
INDIANA UNIVERSITY
Doing business as
Indiana University School of Dentistry
Practice address
1121 W Michigan St
Indianapolis, IN 46202-5211
Phone
(317) 274-7433
NPI assigned
Mar 22, 2007
Last updated
Feb 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

Name
Tina D Foster
Title
Assistant Director of Revenue Cycle
Phone
(317) 278-3632

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X NU
General Practice Dentistry 1223G0001X NU Primary
Periodontics 1223P0300X NU
Prosthodontics 1223P0700X NU
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU
Orofacial Pain Dentistry 1223X2210X NU

Addresses

Primary practice location

1121 W Michigan St
Indianapolis, IN 46202-5211

Mailing address

1121 W Michigan St
Indianapolis, IN 46202-5211
Phone (317) 278-3632

Other identifiers 1

IdentifierTypeStateIssuer
100277260MedicaidIN

Other names 1

  • Indiana University School of Dentistry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040602001625 IN Part B Supplier - Clinic/Group Practice 6002806957 Receives reassigned benefits from 32 practitioners
1 other NPI on this enrollment
Practice locations: Indianapolis, IN
O20221012000151 IN DME Supplier - Oral Surgery - Dentist 6002806957 Practice locations: Indianapolis, IN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
15D0647153Indiana University School of Dentistry1121 W Michigan St S105, Indianapolis, IN 46202ComplianceApr 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Atwater Eye Care Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

2631 E Discovery Pkwy
Bloomington, IN 47408
Phone (812) 353-5252

800 E Atwater Ave
#316
Bloomington, IN 47405
Phone (812) 855-8436

1121 W Michigan St
Indianapolis, IN 46202
Phone (317) 274-7433

1121 W Michigan St
#285
Indianapolis, IN 46202
Phone (317) 274-5628

1121 W Michigan St
#307B
Indianapolis, IN 46202
Phone (317) 274-7433

501 Indiana Ave
Ste 100
Indianapolis, IN 46202
Phone (317) 321-1470

550 University Blvd
#3195
Indianapolis, IN 46202
Phone (317) 274-6300

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Indiana University HealthIndianapolis, IN, CCN 150056 Hospital Operational/Managerial Control Jan 1, 1997
Indiana University HealthIndianapolis, IN, CCN 15S056 Hospital Operational/Managerial Control May 2, 1996
Indiana University Health IncIndianapolis, IN, CCN 157158 Home health agency Operational/Managerial Control Jan 1, 1997
Indiana University Health HospiceIndianapolis, IN, CCN 151511 Hospice Operational/Managerial Control Jan 1, 1997

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 181

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 181

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1689790552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025211",
            "telephone_number": "317-278-3632",
            "fax_number": "317-274-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025211",
            "telephone_number": "317-274-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "317-278-3632"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100277260",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana University School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Indiana University School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.