NPIMap

Organization Active NPI

Sycamore Springs Physician Group LLC

  • Psychiatry Physician
  • Lafayette, IN
National Provider Identifier
1972914539
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SYCAMORE SPRINGS PHYSICIAN GROUP LLC
Practice address
833 Park East Blvd
Lafayette, IN 47905-0785
Phone
(765) 743-4400
Fax
(765) 743-4411
NPI assigned
May 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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

Authorized official

Name
Greg Miller
Title
Evp, Cfo
Phone
(412) 588-3546

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

833 Park East Blvd
Lafayette, IN 47905-0785

Mailing address

833 Park East Blvd
Lafayette, IN 47905-0785
Phone (765) 743-4400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141110001670 IN Part B Supplier - Clinic/Group Practice 2062634991 Receives reassigned benefits from 16 practitioners
Practice locations: Lafayette, IN

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7944 Solution Ctr
Chicago, IL 60677

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1972914539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 PARK EAST BLVD",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479050785",
            "telephone_number": "765-743-4400",
            "fax_number": "765-743-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 PARK EAST BLVD",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479050785",
            "telephone_number": "765-743-4400",
            "fax_number": "765-743-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYCAMORE SPRINGS PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-16",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "EVP, CFO",
        "authorized_official_telephone_number": "412-588-3546"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.