NPIMap

Organization Active NPI

Well Care Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Austin, IN
National Provider Identifier
1104538636
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WELL CARE COMMUNITY HEALTH, INC.
Practice address
25 W Main St
Austin, IN 47102-1303
Phone
(812) 794-8100
Fax
(812) 794-8200
NPI assigned
Dec 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Authorized official

Name
Cathy Sue Jarvis
Title
Revenue Cycle Manager
Phone
(765) 973-9294

Specialties & licenses 1

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

Addresses

Primary practice location

25 W Main St
Austin, IN 47102-1303

Mailing address

2200 W Main St
Richmond, IN 47374-3882
Phone (765) 973-9294

Other names 1

  • Foundations Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200217000539 IN Part B Supplier - Clinic/Group Practice 9335576131 Receives reassigned benefits from 21 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Austin, IN; Centerville, IN; Henryville, IN; Richmond, IN
O20230301002572 IN Part A Provider - Federally Qualified Health Center (FQHC) 9335576131 Practice locations: Austin, IN

Federally qualified health center certification: CCN 151177

Legal name
WELL CARE COMMUNITY HEALTH INC
Doing business as
FOUNDATIONS FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 28, 2023
Last certification
Feb 28, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 4, 2019 in IN
Enrollment address
25 W Main St
Austin, IN 47102-1303

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
David M Keller Individual Corporate Director Jan 3, 2023
Operational/Managerial Control Jan 3, 2023
Eric Coulter Individual 5% Or Greater Direct Ownership Interest Jan 3, 2023
Corporate Director Jan 3, 2023

Owners & managing parties with NPI records 1

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

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777852800000",
    "number": "1104538636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 W MAIN ST",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473743882",
            "telephone_number": "765-973-9294",
            "fax_number": "765-973-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 W MAIN ST",
            "city": "AUSTIN",
            "state": "IN",
            "postal_code": "471021303",
            "telephone_number": "812-794-8100",
            "fax_number": "812-794-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL CARE COMMUNITY HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A",
        "authorized_official_last_name": "JARVIS",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "765-973-9294"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foundations Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, IN

Sources for this page

Verify at the official NPI Registry.