Provider Demographics
NPI:1013319656
Name:BRAIN PERFORMANCE LLC
Entity Type:Organization
Organization Name:BRAIN PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SORGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-441-8499
Mailing Address - Street 1:3003 E. 98TH STREET
Mailing Address - Street 2:SUITE # 107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280
Mailing Address - Country:US
Mailing Address - Phone:463-273-2093
Mailing Address - Fax:317-672-1971
Practice Address - Street 1:3003 E. 98TH STREET
Practice Address - Street 2:SUITE # 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280
Practice Address - Country:US
Practice Address - Phone:463-273-2093
Practice Address - Fax:317-672-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN227830CMedicare PIN