NPIMap

Organization Active NPI

CCCG, LLC

Doing business as Methodist Cardiology Physicians

  • Cardiovascular Disease Physician
  • Indianapolis, IN
National Provider Identifier
1861427775
Registry record updated Sep 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CCCG, LLC
Doing business as
Methodist Cardiology Physicians
Practice address
1801 Senate Blvd
Methodist Professional Center, Suite 310
Indianapolis, IN 46202-1228
Phone
(317) 962-4836
Fax
(317) 962-8646
NPI assigned
Jul 11, 2006
Last updated
Sep 21, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
CLARIAN HEALTH PARTNERS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2007

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

Authorized official

Name
Samuel L Odle
Title
President, Ceo
Phone
(317) 962-4836

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary
Interventional Cardiology Physician 207RI0011X

Addresses

Primary practice location

1801 Senate Blvd
Methodist Professional Center, Suite 310
Indianapolis, IN 46202-1228

Mailing address

250 N Shadeland Ave
Suite 200
Indianapolis, IN 46219-4959
Phone (317) 962-4836

Other names 1

  • Methodist Cardiology Physicians Doing business as

National Provider Directory

National Provider Directory
Part of
Clinical Laboratory SVC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8002 Reliable Pkwy
Chicago, IL 60686

1801 Senate Blvd
Ste 3100
Indianapolis, IN 46202
Phone (317) 962-4400

4880 Century Plaza Rd
Ste 265
Indianapolis, IN 46254
Phone (317) 216-2700

6920 Parkdale Pl
Ste 107
Indianapolis, IN 46254
Phone (317) 329-7333

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1861427775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959",
            "telephone_number": "317-962-4836",
            "fax_number": "317-962-8646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 SENATE BLVD",
            "address_2": "METHODIST PROFESSIONAL CENTER, SUITE 310",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021228",
            "telephone_number": "317-962-4836",
            "fax_number": "317-962-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCCG, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLARIAN HEALTH PARTNERS, INC",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "ODLE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "317-962-4836"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Methodist Cardiology Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 21, 2007; 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.