Southern Indiana Family Practice Center PC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

01055670A Issued in IN

Legal business name

SOUTHERN INDIANA FAMILY PRACTICE CENTER PC

Doing business as

Southern Indiana Family Practice Center

Practice address

3209 W Fullerton Pike
Ste a
Bloomington, IN 47403-4060

Phone

(812) 339-6744

Fax

(812) 671-9113

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Karen L. Reid-Renner, MDNPI 1053375295

Title

Owner

Phone

(812) 339-6744

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Southern Indiana Family Practice Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2076/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karen Lorraine Reid-Renner, MD MPH

  • Family Medicine Physician
  • Bloomington, IN
  • NPI 1053375295
  Medicare reassignment Authorized official
• Jody Lynn Root, FNP-BC

  • Family Nurse Practitioner
  • Bloomfield, IN
  • NPI 1881622900
  Medicare reassignment

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447977600000",
    "number": "1770626152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 W FULLERTON PIKE",
            "address_2": "STE A",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034060",
            "telephone_number": "812-339-6744",
            "fax_number": "812-671-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 W FULLERTON PIKE",
            "address_2": "STE A",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034060",
            "telephone_number": "812-339-6744",
            "fax_number": "812-671-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIANA FAMILY PRACTICE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2015-11-20",
        "status": "A",
        "authorized_official_last_name": "REID-RENNER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-339-6744",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IN",
            "license": "01055670A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71002130A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200367600A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Indiana Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Marie Souers, CTRS
• Soul Insight Counseling Services
• South Central Community Action Program
• South Central Oral & Maxillofacial Surgery, LLC
• Southern Indiana Anesthesiology
• Southern Indiana Hearing Solutions
• Southern Indiana Home Care
• Southern Indiana Pathologists
• Southern Indiana Pediatric Dentistry, LLC
• Southern Indiana Pediatrics, LLC

• Preferred Provider Organization in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Preferred Provider Organization in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.