NPIMap

Organization Active NPI

Sacris Medical Corporation PC

  • Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
  • Valparaiso, IN
National Provider Identifier
1952514895
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VH0002X
License
01025728 Issued in IN
Legal business name
SACRIS MEDICAL CORPORATION PC
Practice address
2000 Roosevelt Rd
Suite 207
Valparaiso, IN 46383-2800
Phone
(219) 462-4042
Fax
(219) 462-1444
NPI assigned
May 7, 2007
Last updated
Oct 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Authorized official

Name
Mr. Michael H Dela Vina
Title
Office Manager
Phone
(219) 462-4042

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician 207VH0002X 01025728 IN Primary

Addresses

Primary practice location

2000 Roosevelt Rd
Suite 207
Valparaiso, IN 46383-2800

Mailing address

PO Box 1338
Valparaiso, IN 46384-1338
Phone (219) 462-4042

Other identifiers 3

IdentifierTypeStateIssuer
000000109115OtherINBLUE CROSS OF INDIANA
100076930AMedicaidIN
90000239OtherINBLUE CROSS OF ILLINOIS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1952514895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1338",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463841338",
            "telephone_number": "219-462-4042",
            "fax_number": "219-462-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 ROOSEVELT RD",
            "address_2": "SUITE 207",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832800",
            "telephone_number": "219-462-4042",
            "fax_number": "219-462-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRIS MEDICAL CORPORATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "DELA VINA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "219-462-4042",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207VH0002X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Hospice and Palliative Medicine",
            "state": "IN",
            "license": "01025728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF INDIANA",
            "identifier": "000000109115",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100076930A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ILLINOIS",
            "identifier": "90000239",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.