Active NPI
John M Diveris, MD
- Orthopaedic Surgery Physician
- Merrillville, IN
National Provider Identifier
1831198324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 01040065A
- Practice address
- 333 W 89TH Ave
Suite W5
Merrillville, IN 46410-7073 - Phone
- (219) 755-4448
- Fax
- (219) 755-4454
- NPI assigned
- Jul 18, 2005
- Last updated
- Aug 27, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 01040065A | IN | Primary |
Addresses
Primary practice location
333 W 89TH Ave
Suite W5
Merrillville, IN 46410-7073
Mailing address
333 W 89TH Ave
Suite W5
Merrillville, IN 46410-7073
Phone (219) 755-4448
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000381584 | Other | IN | ANTHEM |
| 200010670 | 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illiana Surgery and Medical Center | Past | Accepting new patients | |
| Illiana Surgery & Medical Center, LLC | Orthopaedic Surgery | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba The Orthopedics Centers, LLC
- Orthopaedic Surgery Physician
- Merrillville, IN
- NPI 1962401927
-
dba Illiana Rehabilitation Services
- Physical Therapist
- Munster, IN
- NPI 1134175490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1831198324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 W 89TH AVE",
"address_2": "SUITE W5",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464107073",
"telephone_number": "219-755-4448",
"fax_number": "219-755-4454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 W 89TH AVE",
"address_2": "SUITE W5",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464107073",
"telephone_number": "219-755-4448",
"fax_number": "219-755-4454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVERIS",
"first_name": "JOHN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "IN",
"license": "01040065A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000381584",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200010670",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.