| Northside Gastroenterology, Inc., PC | |
|
8424 Naab Rd Suite 3-j Indianapolis IN 46260 | |
| (317) 872-7396 | |
| (317) 879-8328 |
| Full Name | Northside Gastroenterology, Inc., PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 8424 Naab Rd, Indianapolis, Indiana |
| Authorized Official Name and Position | Galinton Bryan (PRACTICE ADMIN) |
| Authorized Official Contact | 3178727396 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Gastroenterology, Inc., PC 8424 Naab Rd Suite 3-j Indianapolis IN 46260-5918 Ph: (317) 872-7396 | Northside Gastroenterology, Inc., PC 8424 Naab Rd Suite 3-j Indianapolis IN 46260 Ph: (317) 872-7396 |
| NPI Number | 1568578201 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 02/08/2019 |
| Medicare PECOS PAC ID | 7618981523 |
|---|---|
| Medicare Enrollment ID | O20060131000311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568578201 | NPI | - | NPPES |
| 100177420 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (NU) | Primary |
| 207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | (NU) | Secondary |
| Provider Name | Spencer a Wilson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1679731046 PECOS PAC ID: 1658422340 Enrollment ID: I20090618000720 |
| Provider Name | Arthur R Baluyut |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1669474292 PECOS PAC ID: 6002913969 Enrollment ID: I20100525000339 |
| Provider Name | Taiseer Shatara |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548252463 PECOS PAC ID: 6901903863 Enrollment ID: I20100526000939 |
| Provider Name | Mark Scheidler |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609878214 PECOS PAC ID: 0547367401 Enrollment ID: I20100526001042 |
| Provider Name | Lawrence Born |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1003818626 PECOS PAC ID: 3274630132 Enrollment ID: I20100610000135 |
| Provider Name | Modeson-samuel Ferrer |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1386711711 PECOS PAC ID: 6800088691 Enrollment ID: I20110826000126 |
| Provider Name | Fyeza S Haider |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376512087 PECOS PAC ID: 4385616978 Enrollment ID: I20121016000023 |
| Provider Name | Anjali S Godambe |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1841448180 PECOS PAC ID: 8426292749 Enrollment ID: I20130926000140 |
| Provider Name | Kerrie R Suits |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629419908 PECOS PAC ID: 8729212725 Enrollment ID: I20131007000353 |
| Provider Name | Ryan M Rosebrough |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487027058 PECOS PAC ID: 8022311034 Enrollment ID: I20160126001311 |
| Provider Name | Kirsten Strausburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427538529 PECOS PAC ID: 7012261951 Enrollment ID: I20181113002133 |
| Provider Name | Samantha L Vanderlaan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932720810 PECOS PAC ID: 0042611097 Enrollment ID: I20210628002379 |
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