NPIMap

Organization Active NPI

Indiana University

  • Audiologist
  • Bloomington, IN
National Provider Identifier
1982693743
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
INDIANA UNIVERSITY
Practice address
200 S Jordan Ave
Bloomington, IN 47405-7002
Phone
(812) 855-4156
Fax
(812) 855-5531
NPI assigned
Oct 14, 2005
Last updated
Feb 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Authorized official

Name
Marcia A Humphress
Title
Fiscal Officer
Phone
(812) 855-4156

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X IN Primary
Speech-Language Pathologist 235Z00000X IN

Addresses

Primary practice location

200 S Jordan Ave
Bloomington, IN 47405-7002

Mailing address

2631 East Discovery Parkway
Health Sciences Building
Bloomington, IN 47408-9059
Phone (812) 855-4156

Other identifiers 1

IdentifierTypeStateIssuer
100276980AMedicaidIN

Other names 1

  • IU Speech and Hearing Clinics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160419002338 IN Part B Supplier - Clinic/Group Practice 6002806957 Receives reassigned benefits from 21 practitioners
Practice locations: Bloomington, IN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Atwater Eye Care Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

2631 E Discovery Pkwy
Rm C2122
Bloomington, IN 47408

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Indiana University HealthIndianapolis, IN, CCN 150056 Hospital Operational/Managerial Control Jan 1, 1997
Indiana University HealthIndianapolis, IN, CCN 15S056 Hospital Operational/Managerial Control May 2, 1996
Indiana University Health IncIndianapolis, IN, CCN 157158 Home health agency Operational/Managerial Control Jan 1, 1997
Indiana University Health HospiceIndianapolis, IN, CCN 151511 Hospice Operational/Managerial Control Jan 1, 1997

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1982693743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 EAST DISCOVERY PARKWAY",
            "address_2": "HEALTH SCIENCES BUILDING",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474089059",
            "telephone_number": "812-855-4156",
            "fax_number": "812-855-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S JORDAN AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474057002",
            "telephone_number": "812-855-4156",
            "fax_number": "812-855-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2021-02-01",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "HUMPHRESS",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "FISCAL OFFICER",
        "authorized_official_telephone_number": "812-855-4156"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100276980A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IU Speech and Hearing Clinics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "IU Speech and Hearing Clinics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.