Provider Demographics
NPI:1831167931
Name:GRIPE, RICHARD THOMPSON (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMPSON
Last Name:GRIPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 N MERIDIAN ST # 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 N MONROE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:IN
Practice Address - Zip Code:47993-1049
Practice Address - Country:US
Practice Address - Phone:765-762-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026247A207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00645962OtherRAILROAD MEDICARE
IN9397099OtherPHCS PID NUMBER
IN000000189254OtherANTHEM PROVIDER NUMBER
INGR80531020Medicaid
IN000000527215OtherANTHEM
IN100231540Medicaid
IN941200ZZMedicare PIN
IN9397099OtherPHCS PID NUMBER
INE03830Medicare UPIN
IN921480CMedicare PIN
IN250670002Medicare PIN