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MICHIANA OB/GYN
Complete NPI Record 1689909848
Obstetrics & Gynecology in South Bend, IN

NPI Status: Active since October 06, 2009

Contact Information

515 N LAFAYETTE BLVD
SOUTH BEND, IN
ZIP 46601
Phone: (574) 232-2037
Fax: (574) 232-1420

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Authorized Official Last Name
  25. Authorized Official First Name
  26. Authorized Official Middle Name
  27. Authorized Official Title or Position
  28. Authorized Official Telephone Number
  29. Healthcare Provider Taxonomy Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Other Provider Identifier 1
  32. Other Provider Identifier Type Code 1
  33. Other Provider Identifier State 1
  34. Is Organization Subpart
  35. Parent Organization LBN
  36. Parent Organization TIN
  37. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1689909848. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1689909848
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: MICHIANA OB/GYN
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 6301 UNIVERSITY COMMONS
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 230
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: SOUTH BEND
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: IN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 466351571
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5742512100
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5742512150
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 515 N LAFAYETTE BLVD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: SOUTH BEND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IN
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 466011003
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5742322037
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5742321420
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/6/2009
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 12/29/2017
The date that a record was last updated or changed.
Authorized Official Last Name: ROUSSARIE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SHERY
The first name of the authorized official.
Authorized Official Middle Name: A.
The middle name of the authorized official.
Authorized Official Title or Position: CEO
The title or position of the authorized official.
Authorized Official Telephone Number: 5742512100
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207V00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 200962980B
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: IN
Is Organization Subpart: Y
Parent Organization LBN: ALLIED PHYSICIANS OF MICHIANA, LLC
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP