Active NPI
Indylife Home Health Care LLC
- Home Health Agency
- Fishers, IN
National Provider Identifier
1083276257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- INDYLIFE HOME HEALTH CARE LLC
- Practice address
- 11679 Tylers Close
Fishers, IN 46037-4359 - Phone
- (317) 457-6656
- NPI assigned
- Jul 8, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kishore Gazula
- Title
- President / Owner
- Phone
- (317) 457-6656
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
11679 Tylers Close
Fishers, IN 46037-4359
Mailing address
11679 Tylers Close
Fishers, IN 46037-4359
Phone (317) 457-6656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200709003670 | IN | Part A Provider - Home Health Agency | 0941623888 | Practice locations: Fishers, IN |
Home health agency certification: CCN 157714
- Legal name
- INDYLIFE HOME HEALTH CARE LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Dec 14, 2020
- Last certification
- Dec 14, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Incorporated
- Jul 8, 2019 in IN
- Enrollment address
- 11679 Tylers Close
Fishers, IN 46037-4359
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Indylife Home Health Care LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- Dec 14, 2020
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Hitesh Patel | 5% Or Greater Direct Ownership Interest | Jul 8, 2019 | 50% |
| Corporate Director | Jul 8, 2019 | 50% | |
| W-2 Managing Employee | Jul 8, 2019 | 100% | |
| Kishore Gazula | 5% Or Greater Direct Ownership Interest | Jul 8, 2019 | 50% |
| Corporate Director | Jul 8, 2019 | 50% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Greencastle, IN
- NPI 1366634214
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1562544000000",
"number": "1083276257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11679 TYLERS CLOSE",
"city": "FISHERS",
"state": "IN",
"postal_code": "460374359",
"telephone_number": "317-457-6656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11679 TYLERS CLOSE",
"city": "FISHERS",
"state": "IN",
"postal_code": "460374359",
"telephone_number": "317-457-6656"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INDYLIFE HOME HEALTH CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-07-08",
"last_updated": "2019-07-08",
"status": "A",
"authorized_official_last_name": "GAZULA",
"authorized_official_first_name": "KISHORE",
"authorized_official_title_or_position": "PRESIDENT / OWNER",
"authorized_official_telephone_number": "317-457-6656"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fishers, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.