Active NPI
Lois Elaine Duryea, DO
- Psychiatry Physician
- Goshen, IN
National Provider Identifier
1891763629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 02001183A
- Practice address
- 330 Lakeview Dr
Goshen, IN 46528-9365 - Phone
- (574) 533-1234
- Fax
- (574) 537-2652
- NPI assigned
- Mar 9, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 02001183A | IN | Primary |
| Psychiatry Physician | 2084P0800X | 02161 | IA |
Addresses
Primary practice location
330 Lakeview Dr
Goshen, IN 46528-9365
Mailing address
PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891763629 | Medicaid | IA |
Other names 1
- Lois Elaine Ham
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 Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02001183A | IN | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Counseling Center | Past | Accepting new patients | |
| Bootheel Counseling Services | 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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Sikeston, MO
- NPI 1700652898
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Centerville, IA
- NPI 1033281084
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248307200000",
"number": "1891763629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 809",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465270809",
"telephone_number": "574-533-1234",
"fax_number": "574-537-2652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 LAKEVIEW DR",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465289365",
"telephone_number": "574-533-1234",
"fax_number": "574-537-2652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURYEA",
"first_name": "LOIS",
"middle_name": "ELAINE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2009-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IN",
"license": "02001183A",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IA",
"license": "02161",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891763629",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LOIS",
"last_name": "HAM",
"middle_name": "ELAINE",
"credential": "DO",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.