Grand Ole Docs of the Southside, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GRAND OLE DOCS OF THE SOUTHSIDE, LLC

Doing business as

Central Indiana Medical Group

Practice address

365 E Main St
Greenwood, IN 46143-1361

Phone

(317) 881-5152

Fax

(317) 881-8993

NPI assigned

Sep 25, 2006

Organization subpart

No

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

Authorized official

Name

Robert V Klaasen, MD

Title

Managing Physician

Phone

(317) 882-6663

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Central Indiana Medical Group Doing business as

Locations

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1871693994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E COUNTY LINE RD",
            "address_2": "SUITE H",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462270873",
            "telephone_number": "317-887-7725",
            "fax_number": "317-887-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 E MAIN ST",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431361",
            "telephone_number": "317-881-5152",
            "fax_number": "317-881-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND OLE DOCS OF THE SOUTHSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "KLAASEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "317-882-6663",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RR MEDICARE #",
            "identifier": "CI4722",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "5457630001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Indiana Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Braeshel Darletha Graham
• Grand Brook Memory Care of Greenwood LLC
• Grand Old Docs of the Southside
• Grand Old Docs of the Southside
• Grand Ole Docs of the Southside, LLC
• Kelly Carlberg Graner, M.D.
• Alyson M Grantham
• Kaci Graphman
• Brenda Graves-Croom
• Aireol Onyae Graves

• Family Medicine Physician in Greenwood, IN
• Providers in Greenwood, 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 Dec 5, 2013; 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.