Grand Ole Docs of the Southside

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01018751A Issued in IN

Legal business name

GRAND OLE DOCS OF THE SOUTHSIDE

Practice address

8921 Southpointe Dr
B1
Indianapolis, IN 46227-0968

Phone

(317) 882-0535

Fax

(317) 882-1415

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Gerald M Dewester, MD

Title

Physician

Phone

(317) 882-0535

Specialties & licenses 1

Addresses

Other names 1

• Central Indiana Medical Group Doing business as

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1851487706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8921 SOUTHPOINTE DR",
            "address_2": "B1",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462270968",
            "telephone_number": "317-882-0535",
            "fax_number": "317-882-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8921 SOUTHPOINTE DR",
            "address_2": "B1",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462270968",
            "telephone_number": "317-882-0535",
            "fax_number": "317-882-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND OLE DOCS OF THE SOUTHSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "DEWESTER",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "317-882-0535",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01018751A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Indiana Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Kathleen Gramke, LMHC
• Anna Gramling, MD
• Tricia Grams
• Richard K Grana, PHD
• Grand Old Docs of the Southside
• Grand Ole Docs of the Southside, LLC
• Grand Ole Docs of the Southside, LLC
• Areli Grande
• Jill Grande, BCBA
• Ana Grandinetti, MD

• Family Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, 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 Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.