Chikare Health Services Inc
Organization Active NPI Primary Care Clinic/Center · East Chicago, IN
NPI 1043375934 · NPPES record last updated Jun 18, 2019
Key facts
- NPI
- 1043375934
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- CHIKARE HEALTH SERVICES INC
- Practice address
- 915 W Chicago Ave
East Chicago, IN 46312 - Phone
- (219) 397-6000
- Fax
- (219) 397-6358
- NPI assigned
- Dec 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Kanayo K Odeluga, MD
- Title
- Owner/MD
- Phone
- (219) 397-6000
Other NPIs on the same Medicare enrollment 1
Practitioners 6
-
Irene Odeluga, MS RN FNP - BC
-
Kanayo K Odeluga, MD, MPH
-
Okosun Edoro, MD
-
Martha Gainer, APN-FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0956269 | Chikare Health Services Inc | Certificate of waiver | Jan 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190618002950 | IN | Part B Supplier - Clinic/Group Practice | 8729311121 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment Practice locations: East Chicago, IN |
National Provider Directory
Locations
915 W Chicago Ave
East Chicago, IN 46312
Phone (219) 397-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
915 W Chicago Ave
East Chicago, IN 46312
Mailing address
915 W Chicago Ave
East Chicago, IN 46312-3308
Phone (219) 397-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15D0956269 | Other | IN | CLIA |
| CG2552 | Other | PALMETO GBA MEDICA | |
| 200210560A | Medicaid | IN |
Other names
- Immanuel Family Health Center
Other providers in East Chicago, IN
- Centro Medico Ruiz-Montero PC
- Cep America LLC
- Mamie Champion
- Deborah Chapman
- Cherish Open Arms PHC LLC
- Chikare Health System PC
- Debbie Choate
- City of East Chicago
- Suzanna Clark
- Cleo Caring Hearts LLC
All providers in East Chicago, IN · Primary Care Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.