Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207X00000X | Orthopaedic Surgery | | 35-05-3520-S | OHIO | No |
| 2 | 207X00000X | Orthopaedic Surgery | | 01037561 | INDIANA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0251123-003 | OTHER | | CIGNA RENDERING # |
| 2 | 645223 | OTHER | | AETNA RENDERING # |
| 3 | ========= | OTHER | | CHAMPUS RENDERING # |
| 4 | 171770A | MEDICARE PIN | INDIANA | |
| 5 | 000000014822 | OTHER | | BLUE SHIELD INDIANA # |
| 6 | 100017200A | MEDICAID | INDIANA | |
| 7 | 0719720001 | MEDICARE NSC | INDIANA | |
| 8 | E27661 | MEDICARE UPIN | | |
| 9 | 010025828 | OTHER | | RAILROAD MEDICARE # |
| 10 | =========001 | OTHER | | TRI-CARD PIN |
| 11 | =========-4A01 | OTHER | | BLUE SHIELD OHIO # |
| 12 | 53520 | OTHER | | CHOICE CARE RENDERING # |
| 13 | 124097500 | OTHER | | DEPT OF LABOR PIN |
| 14 | =========-00 | OTHER | | BWC RENDERING # |
| 15 | 0901330 | OTHER | | UNITED HEALTH CARE |
| 16 | =========-0 | OTHER | | PRUDENTIAL RENDERING # |
