Grand Old Docs of the Southside

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01022713A Issued in IN

Legal business name

GRAND OLD DOCS OF THE SOUTHSIDE

Doing business as

Central Indiana Medical Group

Practice address

8920 Southpointe Dr
Suite E-1
Indianapolis, IN 46227-7509

Phone

(317) 882-0535

Fax

(317) 882-0173

NPI assigned

Oct 17, 2007

Organization subpart

No

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

Authorized official

Name

Robert E Dicks, M.D.

Title

MD/Owner

Phone

(317) 882-0535

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Central Indiana Medical Group Doing business as

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1720277544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E COUNTY LINE RD",
            "address_2": "SUITE I",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462270873",
            "telephone_number": "317-882-0535",
            "fax_number": "317-882-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8920 SOUTHPOINTE DR",
            "address_2": "SUITE E-1",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462277509",
            "telephone_number": "317-882-0535",
            "fax_number": "317-882-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND OLD DOCS OF THE SOUTHSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "DICKS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "317-882-0535",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01022713A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RR MCE #",
            "identifier": "CI4722",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Indiana Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gregory P Gramelspacher, MD
• Sarah Kathleen Gramke, LMHC
• Anna Gramling, MD
• Tricia Grams
• Richard K Grana, PHD
• Grand Ole Docs of the Southside (Central Indiana Medical Group)
• Grand Ole Docs of the Southside, LLC (Central Indiana Medical Group)
• Grand Ole Docs of the Southside, LLC (Central Indiana Medical Group)
• Areli Grande
• Jill Grande, BCBA

• Family Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.