Organization Active NPI

Rheumetology Arthritis Immunology

  • Rheumatology Physician
  • Evansville, IN
National Provider Identifier
1972855138
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
01053981A Issued in IN
Legal business name
RHEUMETOLOGY ARTHRITIS IMMUNOLOGY
Practice address
5015 E Plaza East Blvd
Evansville, IN 47715-2861
Phone
(812) 437-2340
Fax
(812) 491-1972
NPI assigned
Oct 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Moges Sisay, MDNPI 1649264896
Title
Owner
Phone
(812) 437-2340

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
Rheumatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RR0500X 01053981A IN Primary

Addresses

Primary practice location

5015 E Plaza East Blvd
Evansville, IN 47715-2861

Mailing address

5015 E Plaza East Blvd
Evansville, IN 47715-2861
Phone (812) 437-2340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130425000642 IN Part B Supplier - Clinic/Group Practice 1557507167 Receives reassigned benefits from 1 practitioner
Practice locations: Evansville, IN

National Provider Directory

National Provider Directory

Locations

5015 E Plaza East Blvd
Evansville, IN 47715
Phone (812) 437-2340

4933 E Plaza East Blvd
Evansville, IN 47715
Phone (812) 401-8720

Practitioners & affiliated clinicians

Practitioners 1

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": "1349913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1972855138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 E PLAZA EAST BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152861",
            "telephone_number": "812-437-2340",
            "fax_number": "812-491-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5015 E PLAZA EAST BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152861",
            "telephone_number": "812-437-2340",
            "fax_number": "812-491-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RHEUMETOLOGY ARTHRITIS IMMUNOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-11",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "SISAY",
        "authorized_official_first_name": "MOGES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-437-2340",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IN",
            "license": "01053981A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.