Jodi S Clouse, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01050876 Issued in IN

Practice address

1033 North Indiana Avenue
Syracuse, IN 46567

Phone

(574) 457-5701

Fax

(574) 457-5609

NPI assigned

Aug 30, 2006

Last updated

Oct 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jodi.clouse.1@30520.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Doctor on Demand Professionals P C

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1174931448

  IN

  Medicare reassignment
• Fort Wayne Medical Education Program

  dba The Family Medicine Center

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1184635153
  NPD (past)
• Syracuse Family Practice, LLC

  • Family Medicine Physician
  • Syracuse, IN
  • NPI 1770613879
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1730299603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "SYRACUSE",
            "state": "IN",
            "postal_code": "46567",
            "telephone_number": "574-457-5701",
            "fax_number": "574-457-5609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 NORTH INDIANA AVENUE",
            "city": "SYRACUSE",
            "state": "IN",
            "postal_code": "46567",
            "telephone_number": "574-457-5701",
            "fax_number": "574-457-5609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUSE",
        "first_name": "JODI",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "MD16489",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101266076",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2019-00100",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01050876",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "S0441",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "65197",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200187460",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Boyd
• Brandi Miller
• Shane M. Bullick, MA
• Diana Maureen Byron, LCSW
• Jack Prow Clark, M.D.
• Olivia Cook
• Randall Steven Cory, DDS
• Christopher Craig
• Dr Rod Kaufman, Optometrist, Inc.
• Chris Dykhuisen

• Family Medicine Physician in Syracuse, IN
• Providers in Syracuse, 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 Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.