NPIMap

Organization Active NPI

Green Pediatrics LLC

  • Pediatrics Physician
  • Saint John, IN
National Provider Identifier
1922462811
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01064437A Issued in IN
Legal business name
GREEN PEDIATRICS LLC
Practice address
8247 Wicker Ave
Saint John, IN 46373-8878
Phone
(219) 662-3931
NPI assigned
Apr 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Authorized official

Name
Dr. Biljana Uzelac, M.D.NPI 1164605036
Title
Owner / President
Phone
(219) 662-3931

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 01064437A IN Primary

Addresses

Primary practice location

8247 Wicker Ave
Saint John, IN 46373-8878

Mailing address

PO Box 1153
Crown Point, IN 46308-1153
Phone (219) 662-3931

Other identifiers 1

IdentifierTypeStateIssuer
201361020AMedicaidIN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2114373Green Pediatrics8247 Wicker Ave, St John, IN 46373Certificate of waiverJun 12, 2028

National Provider Directory

National Provider Directory

Locations

8247 Wicker Ave
Saint John, IN 46373
Phone (219) 232-2771

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1922462811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1153",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463081153",
            "telephone_number": "219-662-3931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8247 WICKER AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738878",
            "telephone_number": "219-662-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-07",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "UZELAC",
        "authorized_official_first_name": "BILJANA",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "219-662-3931",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01064437A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201361020A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint John, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.