Organization Active NPI

St Margaret Mercy Healthcare Centers Inc

Doing business as Dyer Pediatric Services

  • Pediatrics Physician
  • Dyer, IN
National Provider Identifier
1962572354
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ST MARGARET MERCY HEALTHCARE CENTERS INC
Doing business as
Dyer Pediatric Services
Practice address
840 Richard Rd
Suite # 4
Dyer, IN 46311-1994
Phone
(219) 322-7171
Fax
(219) 864-2087
NPI assigned
Nov 9, 2006
Last updated
Jun 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Thomas Gryzbek
Title
President
Phone
(219) 932-2300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

840 Richard Rd
Suite # 4
Dyer, IN 46311-1994

Mailing address

PO Box 1000
Dyer, IN 46311-0800
Phone (219) 864-2107

Other identifiers 2

IdentifierTypeStateIssuer
0090000854OtherILBCBS GROUP NUMBER
200159110LMedicaidIN

Other names 1

  • Dyer Pediatric Services Doing business as

National Provider Directory

National Provider Directory

Locations

840 Richard Rd
Ste 4
Dyer, IN 46311
Phone (219) 322-0487

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1962572354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463110800",
            "telephone_number": "219-864-2107",
            "fax_number": "219-864-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 RICHARD RD",
            "address_2": "SUITE # 4",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111994",
            "telephone_number": "219-322-7171",
            "fax_number": "219-864-2087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARGARET MERCY HEALTHCARE CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "GRYZBEK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-932-2300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0090000854",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200159110L",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dyer Pediatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyer, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.