PHILLIP R KINGMA (NPI# 1629038419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629038419 |
| Entity Type | Individual |
| Full Name | PHILLIP R KINGMA |
| Credential | M.D. |
| Practice Address |
12289 Hancock St Ste 34 Carmel IN 46032-5888 |
| Practice Telephone | 3178158950 |
| Practice Fax Number | 3178158951 |
| Mailing Telephone | 3178158950 |
| Mailing Fax Number | 3178158951 |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-09-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
01040487 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | IN LIC # | IN01040487 | 01 |
| IN | TAX ID # | 208391569 | 01 |
| OH | OH LIC # | 35.088877 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7301 N Shadeland Ave, Suite 1a, Indianapolis, IN 462502085 | 3175771800 | 3175701805 |
| Street Address |
12289 HANCOCK ST STE 34 |
| City | CARMEL |
| State | IN |
| Zip Code | 46032-5888 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013322841 | Margaret K Vanderveen | Nurse Practitioner | 12289 Hancock St Ste 34, Carmel, IN 46032-5888 | 2014-07-01 |
| 1497785273 | Midwest Pain Institute Center for Minimally Invasive Spine PC | Pain Medicine | 12289 Hancock St Ste 34, Carmel, IN 46032-5888 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235769662 | Sharon M.b. Tedder | Counselor | 1980 E. 116th St., Suite 220, Carmel, IN 46032 | 2020-01-24 |
| 1144869983 | Genesia Simmons | Occupational Therapy Assistant | 118 Medical Drive, Carmel, Indiana, OH 46032 | 2019-12-26 |
| 1962069088 | Dei of Indiana, Inc. | Optometrist | 3985 W. 106th Street, Suite 120, Carmel, IN 46032 | 2019-05-23 |
| 1427518737 | Ayesha Kias | Physical Therapist | Lifespan Therapy, 118 Medical Drive, Carmel, IN 46032 | 2019-03-22 |
| 1104305952 | Megan Nicole Neitling | Counselor | 600 E Carmel Dr Ste 146, Carmel, IN 46032 | 2018-08-13 |
| 1154817427 | Open Doors Counseling and Consulting LLC | Nurse Practitioner | 11495 N Pennsylvania, Suite 105, Carmel, IN 46032 | 2018-07-10 |
| 1326533837 | Emily Jo Hardy | Physical Therapy Assistant | Lifespan Therapy 118 Medical Drive, Carmel, IN 46032 | 2018-06-27 |
| 1770086845 | Erin Reagan | Occupational Therapist | 1118 Havest Ct., Carmel, IN 46032 | 2018-03-14 |
| 1356859748 | Maricelia Serrano | Physical Therapy Assistant | Lifespan Therapy, 118 Medical Drive, Carmel, IN 46032 | 2018-01-19 |
| 1417472234 | Leigh Anne Rozsas | Pharmacist | 1424 S Rangeline Road, Carmel, IN 46032 | 2017-08-14 |
| Find all providers in zip 46032 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619976123 | Steven Levine | Pain Medicine | 12289 Hancock St, Suite 34, Carmel, IN 46032-5801 | 2005-07-18 |
| 1619285087 | Advanced Pain Treatments | Pain Medicine | 301 E Carmel Dr, Suite D-100, Carmel, IN 46032-2888 | 2010-09-20 |
| 1922129899 | Interventional Pain Care Associates, LLC | Pain Medicine | 12188a N Meridian St, Suite 105, Carmel, IN 46032-4406 | 2007-04-02 |
| 1497785273 | Midwest Pain Institute Center for Minimally Invasive Spine PC | Pain Medicine | 12289 Hancock St Ste 34, Carmel, IN 46032-5888 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578176087 | Pg Pro LLC | Pain Medicine | 4715 Statesmen Dr Ste Ab, Indianapolis, IN 46250-5642 | 2020-08-25 |
| 1942818109 | Advanced Pain Treatment of Chicago Sc | Pain Medicine | 1950 45th St Ste 101, Munster, IN 46321-3958 | 2020-07-14 |
| 1871050781 | Pain Management Solution LLC | Pain Medicine | 4010 W Goeller Blvd Ste C, Columbus, IN 47201-8312 | 2019-02-27 |
| 1841764495 | Pain Management Centers of America, Psc | Pain Medicine | 1717 S State Road 57 Ste F, Washington, IN 47501-4179 | 2019-01-16 |
| 1982185641 | Midwest Pain Institute Center for Minimally Invasive Spine PC | Pain Medicine | 7301 N Shadeland Ave Ste 1a, Indianapolis, IN 46250-2085 | 2018-08-22 |
| 1679088405 | Advanced Pain Care Clinic Psc | Pain Medicine | 5320 Weston Rd, Evansville, IN 47712-3701 | 2017-12-01 |
| 1730612698 | Advanced Pain Care Clinic Psc | Pain Medicine | 1813 Willow St Ste 3b, Vincennes, IN 47591 | 2017-04-07 |
| 1366987513 | Gary Gettelfinger Md Dabpm LLC | Pain Medicine | 1619 N Prairie Green Ct, Bloomington, IN 47408-8701 | 2016-12-27 |
| 1053785774 | Michael P Royalty Md LLC | Pain Medicine | 4888 Lost Lake Ct, Boonville, IN 47601 | 2015-11-18 |
| 1801938642 | Michael G. Cassaro, Md, Psc | Pain Medicine | 200 Missouri Ave, Suite B, Jeffersonville, IN 47130-3061 | 2007-02-12 |
| Find all providers with the same taxonomy | ||||
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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.