NPIMap

Organization Active NPI

Indianapolis Neurosurgical Group

Doing business as Goodman Campbell Brain and Spine

  • Neurological Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1689903635
Registry record updated Dec 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
INDIANAPOLIS NEUROSURGICAL GROUP
Doing business as
Goodman Campbell Brain and Spine
Practice address
1001 W 10TH St
RG 4TH Floor
Indianapolis, IN 46202-2859
Phone
(317) 630-7625
Fax
(317) 630-8721
NPI assigned
Dec 21, 2009
Last updated
Dec 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2009

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

Authorized official

Name
Derek Cantrell, CFO
Title
Chief Financial Officer
Phone
(317) 396-1300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Neurological Surgery Physician 207T00000X NU Primary

Addresses

Primary practice location

1001 W 10TH St
RG 4TH Floor
Indianapolis, IN 46202-2859

Mailing address

8333 Naab Rd
Suite 250
Indianapolis, IN 46260-5924
Phone (317) 396-1300

Other identifiers 1

IdentifierTypeStateIssuer
100318390MedicaidIN

Other names 1

  • Goodman Campbell Brain and Spine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Goodman Campbell Brain and Spine21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

1001 W 10th St
Fl 4
Indianapolis, IN 46202
Phone (317) 630-7979

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261353600000",
    "number": "1689903635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8333 NAAB RD",
            "address_2": "SUITE 250",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605924",
            "telephone_number": "317-396-1300",
            "fax_number": "317-396-1346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W 10TH ST",
            "address_2": "RG 4TH FLOOR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022859",
            "telephone_number": "317-630-7625",
            "fax_number": "317-630-8721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANAPOLIS NEUROSURGICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-21",
        "last_updated": "2009-12-21",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "317-396-1300",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100318390",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodman Campbell Brain and Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.