Provider Demographics
NPI:1619105244
Name:COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY PHYSICIANS OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:YELETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-355-5555
Mailing Address - Street 1:7240 SHADELAND STATION
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3944
Mailing Address - Country:US
Mailing Address - Phone:317-355-5555
Mailing Address - Fax:317-355-8716
Practice Address - Street 1:7240 SHADELAND STATION
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3944
Practice Address - Country:US
Practice Address - Phone:317-355-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200969250AMedicaid
IN200969250EMedicaid
IN201018890GMedicaid
IN000000647913OtherANTHEM
IN200969250LMedicaid
IN200969250CMedicaid
IN200969250HMedicaid
IN200969250KMedicaid
IN200969250MMedicaid
IN201006200OMedicaid
IN200969250FMedicaid
IN200969250IMedicaid
IN200969250JMedicaid
IN200969250BMedicaid
IN200969250DMedicaid
IN200969250GMedicaid
IN201014430TMedicaid
IN200969250KMedicaid