PAUL WILLIAM HALCZENKO (NPI# 1194954420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194954420 |
| Entity Type | Individual |
| Full Name | PAUL WILLIAM HALCZENKO |
| Credential | MD |
| Practice Address |
2001 W 86th St Indianapolis IN 46260-1902 |
| Mailing Address |
10330 N Meridian St # 300 Indianapolis IN 46290-1024 |
| Practice Telephone | 3173388861 |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2017-04-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
01071583A | IN | Allopathic & Osteopathic Physicians |
| N | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
426479 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 001393000 | 05 | |
| FL | MEDICARE PTAN | CH862Z | 01 |
| Street Address |
2001 W 86TH ST |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46260-1902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021829 | Bassem I Razzouk | Pediatrics | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2005-05-27 |
| 1881209294 | Jennifer L Maupin | Nurse Practitioner | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-09-11 |
| 1851904973 | Taylor Anne Vandervort | Registered Nurse | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-08-28 |
| 1437762796 | Casey Michelle O'neal | Registered Nurse | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-08-26 |
| 1396360590 | Kathleen Sue Lilegdon | Dietitian, Registered | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-06-12 |
| 1033732979 | Rachel Leigh Thelen | Physician Assistant | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-05-27 |
| 1942823976 | Shelby Nichole Preston | Dietitian, Registered | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-05-26 |
| 1396367165 | Gabrielle Ann Vickery | Registered Nurse | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-05-14 |
| 1154950798 | Kaylee Elizabeth Poole | Pharmacist | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-04-06 |
| 1326677014 | Julie Mary Bittar | Student in an Organized Health Care Education/Training Program | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508478298 | Verity Smile Studio, LLC | Clinic/Center | 1619 W. 86th St Suite B, Indianapolis, IN 46260 | 2020-08-23 |
| 1225666589 | Alexander Michael Kiel | Student in an Organized Health Care Education/Training Program | Internal Medicine 3 North, 2001 W. 86th Street, Indianapolis, IN 46260 | 2020-03-31 |
| 1043793151 | Lisa R Foreman | Registered Nurse | 1389 W. 86th Street Unit # 238, Indianapolis, IN 46260 | 2018-09-13 |
| 1790268399 | Esther Muturi | Chore Provider | 1214 Racquetclub South Drive Apt C, Indianapolis, IN 46260 | 2018-09-10 |
| 1912483215 | Katherine Donnelly | Community Health Worker | 1612 Lancashire Ct, Indianapolis, IN 46260 | 2018-07-19 |
| 1326539628 | Peaceful Source Midwifery LLC | Advanced Practice Midwife | 1139 Canterbury Ct., Unit B, Indianapolis, IN 46260 | 2018-05-22 |
| 1144722695 | Mindful Services Center LLC | Clinic/Center | 9002 N Meridian St, Ste 200, Indianapolis, IN 46260 | 2018-03-01 |
| 1144731910 | Meenu Jain | Student in an Organized Health Care Education/Training Program | Internal Medicine, 8414 Naab Road, Suite 100, Indianapolis, IN 46260 | 2017-10-19 |
| 1609392422 | 1717 Senior Living, LLC | Assisted Living Facility | 1703 West 86th Street, Indianapolis, IN 46260 | 2017-08-15 |
| 1093246985 | Royalty Transports LLC | Bus | 2255 W. 67th St., Indianapolis, IN 46260 | 2017-03-23 |
| Find all providers in zip 46260 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619219995 | Casey Kathleen Mccluskey | Pediatrics | 705 Riley Hospital Dr Rm 5867, Pediatric Residency Program Indiana University Som, Indianapolis, IN 46202-5109 | 2013-03-25 |
| 1396001194 | Michelle M Gombas | Pediatrics | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2012-04-05 |
| 1922213057 | Jiuann-huey Ivy Lin | Pediatrics | 705 Riley Hospital Dr, Rr 127, Indianapolis, IN 46202-5109 | 2007-05-11 |
| 1053416784 | David F Westenkirchner | Pediatrics | 705 Riley Hospital Dr, Roc 4270, Indianapolis, IN 46202-5109 | 2006-09-14 |
| 1871602995 | Howard Eigen | Pediatrics | 705 Riley Hospital Dr, Ri 2117, Indianapolis, IN 46202-5109 | 2006-08-30 |
| 1851342208 | Jeffrey C Benson | Pediatrics | 705 Riley Hospital Dr, Roc 4270, Indianapolis, IN 46202-5109 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225169196 | Pediatric Pulmonary & Critical Care, PC | Pediatrics | 7910 West Jefferson Blvd., Ste 205, Fort Wayne, IN 46804-4159 | 2007-03-09 |
| 1023198926 | Pediatric Specialty Physicians, PC | Pediatrics | 7429 Inverness Commons, Fort Wayne, IN 46804-3837 | 2006-10-16 |
| 1336161868 | Chandrashekhar Yalamanchali | Pediatrics | 11123 Parkview Plaza Dr Ste 202, Fort Wayne, IN 46845-1707 | 2006-07-24 |
| 1467408237 | Beacon Medical Group, Inc. | Pediatrics | 615 N Michigan St Fl 5, South Bend, IN 46601 | 2006-05-25 |
| 1962496661 | Susanna R Burkhead | Pediatrics | 3700 Washington Avenue, Evansville, IN 47750-0001 | 2005-09-08 |
| 1184012130 | Hari Rasad Gourabathini | Pediatrics | 615 N Michigan St Fl 5, South Bend, IN 46601-1033 | 2014-12-29 |
| 1972892958 | Patrick J Noonan | Pediatrics | 7950 W Jefferson Blvd Ste 210, Fort Wayne, IN 46804-4140 | 2011-03-30 |
| 1922193184 | Reuben Cohen | Pediatrics | 600 Mary St, Evansville, IN 47747-0001 | 2006-10-04 |
| 1427087188 | Taveepong Terayanont | Pediatrics | 3700 Washington Ave, Evansville, IN 47714-0541 | 2006-07-02 |
| 1063419166 | Daniel Abraha | Pediatrics | 7950 W Jefferson Blvd, Suite 210, Fort Wayne, IN 46804-4140 | 2005-07-05 |
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| City | INDIANAPOLIS |
| Zip Code | 46260 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.