NPIMap

Organization Active NPI

Summerlin Otology Inc

  • Otolaryngology Physician
  • Indianapolis, IN
National Provider Identifier
1952388837
Registry record updated May 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
01017561 Issued in IN
Legal business name
SUMMERLIN OTOLOGY INC
Practice address
3351 N Meridian St
Suite 100
Indianapolis, IN 46208-4674
Phone
(317) 923-5439
Fax
(317) 923-4633
NPI assigned
Dec 30, 2005
Last updated
May 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2008

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

Authorized official

Name
Dr. Jack D Summerlin, MD
Title
President MD
Phone
(317) 923-5439

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 01017561 IN Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

3351 N Meridian St
Suite 100
Indianapolis, IN 46208-4674

Mailing address

3351 N Meridian St
Suite 100
Indianapolis, IN 46208-4674
Phone (317) 923-5439

Other identifiers 4

IdentifierTypeStateIssuer
100119090AMedicaidIN
041068120OtherINRAILROAD
200891910AMedicaidIN
100065670CMedicaidIN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210550400000",
    "number": "1952388837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 N MERIDIAN ST",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084674",
            "telephone_number": "317-923-5439",
            "fax_number": "317-923-4633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 N MERIDIAN ST",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084674",
            "telephone_number": "317-923-5439",
            "fax_number": "317-923-4633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERLIN OTOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-30",
        "last_updated": "2008-05-12",
        "status": "A",
        "authorized_official_last_name": "SUMMERLIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT MD",
        "authorized_official_telephone_number": "317-923-5439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01017561",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100119090A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "041068120",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200891910A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100065670C",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 12, 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.