NPIMap

Organization Active NPI

Open Door Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Muncie, IN
National Provider Identifier
1104133511
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR HEALTH SERVICES, INC.
Practice address
2600 W White River Blvd
Muncie, IN 47303-5263
Phone
(765) 286-7000
NPI assigned
Sep 7, 2010
Last updated
Nov 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
OPEN DOOR HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Authorized official

Name
Mr. Bryan Ayars
Title
Chief Executive Officer
Phone
(765) 747-2971

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2600 W White River Blvd
Muncie, IN 47303-5263

Mailing address

PO Box 1676
Muncie, IN 47308-1676
Phone (765) 286-7000

Other practice location 1

215 S Hutchinson Ave
Muncie, IN 47303
Phone (765) 286-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000592 IN Part B Supplier - Clinic/Group Practice 5890696603 Receives reassigned benefits from 58 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Muncie, IN; Hartford City, IN; Anderson, IN
O20190409002391 IN Part A Provider - Federally Qualified Health Center (FQHC) 5890696603 Practice locations: Muncie, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104133511. Details of each certification follow.

Federally qualified health center certification: CCN 151046

Legal name
OPEN DOOR HEALTH SERVICES INC
Doing business as
OPEN DOOR PEDIATRICS AND FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2019
Last certification
Apr 4, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1998 in IN
Enrollment address
2600 W White River Blvd
Muncie, IN 47303-5263

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
15D2267931Open Door Health Services, Inc2600 W White River Blvd, Muncie, IN 47303Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory
Part of
Open Door BMH Health Center

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Allen Johnstone Individual Corporate DirectorBoard Member Apr 18, 2019
Maricel Driscoll Individual Corporate DirectorBoard Member Feb 24, 2023
Susan Dillon Individual Corporate DirectorBoard Member Mar 25, 2020
Patricia Kennedy Individual Corporate DirectorBoard Member Apr 18, 2019
Alan Spaulding Individual Corporate DirectorBoard Member Mar 2, 2023
Jeff Huff Individual Corporate DirectorBoard Member Apr 18, 2019
Open Door Health Services Inc Organization, Muncie, IN Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2018 100%
Jennifer Parks-Strack Individual Corporate DirectorBoard Member Jan 20, 2021
Michelle a Altobella Individual Corporate DirectorBoard Member Apr 18, 2019
Jean Marie Place Individual Corporate DirectorBoard Member Oct 7, 2020
Kenyonta Hudson Individual Corporate DirectorBoard Member Apr 18, 2019
Bryan W Ayars Individual Corporate DirectorChief Executive Officer Aug 1, 2018 100%
Operational/Managerial ControlChief Executive Officer Aug 1, 2018 100%
Kathy L Vermeulen Individual Corporate DirectorBoard Member Nov 21, 2019
Annette Craycraft Individual Corporate DirectorBoard Member Sep 18, 2019

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Open Door School-Based HealthMuncie, IN, CCN 151135 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 24, 1997
Open Door Health Services Blackford CountyHartford City, IN, CCN C51032 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 2024
Open Door Health Services YMCAMuncie, IN, CCN C51091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2025

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1104133511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1676",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473081676",
            "telephone_number": "765-286-7000",
            "fax_number": "765-213-2769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 W WHITE RIVER BLVD",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473035263",
            "telephone_number": "765-286-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 S Hutchinson Ave",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "47303",
            "country_code": "US",
            "telephone_number": "765-286-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPEN DOOR HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR HEALTH SERVICES, INC.",
        "enumeration_date": "2010-09-07",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "AYARS",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "765-747-2971",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

Verify at the official NPI Registry.