Active NPI
Ruta Gandhi, MD
- Otolaryngic Allergy Physician
- South Bend, IN
National Provider Identifier
1801825336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngic Allergy Physician
- License
- 01038895
- Practice address
- 621 Memorial Dr
Suite 403
South Bend, IN 46601-1063 - Phone
- (574) 232-4800
- NPI assigned
- Jun 30, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngic Allergy Physician | 207YX0602X | 01038895 | IN | Primary |
Addresses
Primary practice location
621 Memorial Dr
Suite 403
South Bend, IN 46601-1063
Mailing address
PO Box 1916
South Bend, IN 46634-1916
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000085506 | Other | IN | ANTHEM PIN |
| 01038895 | Other | IN | LICENSE |
| 100351720A | 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 |
|---|---|---|---|
| 01038895 | IN | MD | Otolaryngic Allergy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1801825336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1916",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466341916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 MEMORIAL DR",
"address_2": "SUITE 403",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011063",
"telephone_number": "574-232-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANDHI",
"first_name": "RUTA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0602X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngic Allergy",
"state": "IN",
"license": "01038895",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PIN",
"identifier": "000000085506",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "01038895",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100351720A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.