INDIANA UNIVERSITY MEDICAL GENETICS SERVICE, INC. (NPI# 1780637058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780637058 |
| Entity Type | Organization |
| Organization Name | INDIANA UNIVERSITY MEDICAL GENETICS SERVICE, INC. |
| Practice Address |
975 W Walnut St Indianapolis IN 46202-5181 |
| Mailing Address |
250 N Shadeland Ave Suite 130 Indianapolis IN 46219-4959 |
| Practice Telephone | 3172742966 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-08-01 |
| Authorized Official Name | DR. BRYAN E HAINLINE (PHYSICIAN) |
| Authorized Official Telephone | 3172742966 |
| Authorized Official Credential | MD, PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
IN | Allopathic & Osteopathic Physicians | |
| N | 207SG0203X |
Medical Genetics Specialization: Clinical Molecular Genetics |
IN | Allopathic & Osteopathic Physicians | |
| N | 207SM0001X |
Medical Genetics Specialization: Molecular Genetic Pathology |
IN | Allopathic & Osteopathic Physicians | |
| Y | 207SC0300X |
Medical Genetics Specialization: Clinical Cytogenetic |
IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100460350 | 05 |
| Street Address |
975 W WALNUT ST |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-5181 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093797565 | Lisa J. Cushman | Genetic Counselor, MS | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2005-11-18 |
| 1427421932 | Katelyn Burns | Psychologist | 975 W Walnut St, Suite Ib-130, Indianapolis, IN 46202-5181 | 2015-11-05 |
| 1558765180 | Kayla Treat | Counselor | 975 W Walnut St, Ib-130, Indianapolis, IN 46202-5181 | 2014-10-10 |
| 1598041246 | Stephanie B Gurnon | Genetic Counselor, MS | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2011-10-26 |
| 1740566561 | Katherine L Sapp | Genetic Counselor, MS | 975 W Walnut St, Ib-130, Indianapolis, IN 46202-5181 | 2011-10-25 |
| 1922199660 | Virginia C. Thurston | Medical Genetics, Ph.D. Medical Genetics | 975 W Walnut St, Ib 264, Indianapolis, IN 46202-5181 | 2006-09-27 |
| 1154431567 | Bryan E Hainline | Medical Genetics | 975 W Walnut St, Indianapolis, IN 46202-5181 | 2006-08-30 |
| 1508822545 | David D Weaver | Medical Genetics | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2006-04-26 |
| 1487610051 | Wilfredo Torres-martinez | Medical Genetics | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2006-04-24 |
| 1649236217 | Gail H Vance | Medical Genetics | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2006-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 207SC0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Cytogenetic |
| A clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular components, particularly chromosomes, associated with heredity. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. A general certificate was first issued by the ABMS in 1982. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932304326 | Mary Margaret Davis | Medical Genetics | 2560 N Shadeland Ave Ste A, Indianapolis, IN 46219-1706 | 2007-06-18 |
| 1649236217 | Gail H Vance | Medical Genetics | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2006-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689654204 | Janice Zunich | Medical Genetics | Community Diagnostic Center, 10020 Donald Powers Dr., Munster, IN 46321 | 2006-01-19 |
| 1235399726 | Northwest Center Medical Services Corp | Medical Genetics | 3400 Broadway, Gary, IN 46408-1101 | 2008-06-10 |
| City | INDIANAPOLIS |
| Zip Code | 46202 |
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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.