Active NPI
Melvin Jay Prince, M.D.
- Internal Medicine Physician
- Indianapolis, IN
National Provider Identifier
1982245593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01039882A
- Practice address
- Gennesaret Free Clinic 615 N Alabama St
Suite 136
Indianapolis, IN 46204 - Phone
- (317) 639-5645
- NPI assigned
- Oct 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 01039882A | IN | |
| Internal Medicine Physician | 207R00000X | 01039882A | IN | Primary |
Addresses
Primary practice location
Gennesaret Free Clinic 615 N Alabama St
Suite 136
Indianapolis, IN 46204
Mailing address
9510 N. Kissell Rd.
Zionsville, IN 46077
Phone (317) 507-3986
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01039882A | IN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570147200000",
"number": "1982245593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9510 N. KISSELL RD.",
"city": "ZIONSVILLE",
"state": "IN",
"postal_code": "46077",
"telephone_number": "317-507-3986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "GENNESARET FREE CLINIC 615 N ALABAMA ST",
"address_2": "SUITE 136",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46204",
"telephone_number": "317-639-5645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRINCE",
"first_name": "MELVIN",
"middle_name": "JAY",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-04",
"last_updated": "2019-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "IN",
"license": "01039882A",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01039882A",
"primary": true
}
],
"identifiers": [],
"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 Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.