NPIMap

Organization Active NPI

Proactive Mso, LLC

Doing business as Proactive MD

  • Primary Care Clinic/Center
  • Plymouth, IN
National Provider Identifier
1083250351
Registry record updated Sep 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROACTIVE MSO, LLC
Doing business as
Proactive MD
Proactive MD Plymouth Health Center
Practice address
510 W Adams St Ste GL30
Plymouth, IN 46563-1784
Phone
(812) 645-1892
NPI assigned
Nov 21, 2019
Last updated
Sep 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark A Kemble, MD
Title
Chief Medical Officer
Phone
(864) 640-8355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

510 W Adams St Ste GL30
Plymouth, IN 46563-1784

Mailing address

86 Villa Rd Ste 100
Greenville, SC 29615-3052
Phone (864) 640-8355

Other names 2

  • Proactive MD Doing business as
  • Proactive MD Plymouth Health Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2182131Proactive MD - Plymouth510 West Adams Suite GL30, Plymouth, IN 46563Certificate of waiverApr 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
W Lafayette Health Center35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

510 W Adams St
Ste GL30
Plymouth, IN 46563
Phone (574) 935-8565

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788825600000",
    "number": "1083250351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 VILLA RD STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153052",
            "telephone_number": "864-640-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W ADAMS ST STE GL30",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631784",
            "telephone_number": "812-645-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MSO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-21",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "864-640-8355",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proactive MD Plymouth Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.