Active NPI
Maryellen E Gusic, MD
- Pediatrics Physician
- Indianapolis, IN
National Provider Identifier
1760432397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 01069711A
- Practice address
- 705 Riley Hospital Dr
Suite 1300
Indianapolis, IN 46202-5109 - Phone
- (317) 944-2801
- Fax
- (317) 944-5630
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD053599L | PA | |
| Pediatrics Physician | 208000000X | 01069711A | IN | Primary |
Addresses
Primary practice location
705 Riley Hospital Dr
Suite 1300
Indianapolis, IN 46202-5109
Mailing address
950 N Meridian Street
Suite 500 - Provider Enrollment
Indianapolis, IN 46204-3908
Phone (317) 963-0595
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0014850040010 | Medicaid | PA | |
| 201055470 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD053599L | PA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Family Physicians, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1043275787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375142400000",
"number": "1760432397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 N MERIDIAN STREET",
"address_2": "SUITE 500 - PROVIDER ENROLLMENT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462043908",
"telephone_number": "317-963-0595",
"fax_number": "317-962-4950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 RILEY HOSPITAL DR",
"address_2": "SUITE 1300",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025109",
"telephone_number": "317-944-2801",
"fax_number": "317-944-5630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSIC",
"first_name": "MARYELLEN",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2013-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD053599L",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01069711A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0014850040010",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201055470",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}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 Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.