NPIMap

Organization Active NPI

Hendricks County Hospital

Doing business as Green St Family Medicine

  • Family Medicine Physician
  • Brownsburg, IN
National Provider Identifier
1104600048
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HENDRICKS COUNTY HOSPITAL
Doing business as
Green St Family Medicine
Practice address
1080 N Green St Ste 200
Brownsburg, IN 46112-2417
Phone
(317) 386-5628
Fax
(317) 386-5629
NPI assigned
Aug 22, 2023
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
HENDRICKS COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Heather Rutherford
Title
Credentialing Coordinator
Phone
(317) 837-5566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1080 N Green St Ste 200
Brownsburg, IN 46112-2417

Mailing address

1100 Southfield Dr Ste 1370
Plainfield, IN 46168-4300
Phone (317) 837-5566

Other names 1

  • GREEN ST FAMILY MEDICINE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040811000309 IN Part B Supplier - Clinic/Group Practice 4880505528 Receives reassigned benefits from 431 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Brownsburg, IN; Danville, IN; Greencastle, IN; Lizton, IN; Plainfield, IN; Avon, IN; Bainbridge, IN

National Provider Directory

National Provider Directory
Tax ID family
Indiana Adult Pediatr110 organizations share this tax ID, including this one
Part of
Indiana Adult Pediatr

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1100 Southfield Dr
Ste 1330
Plainfield, IN 46168
Phone (317) 837-5510

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1104600048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SOUTHFIELD DR STE 1370",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461684300",
            "telephone_number": "317-837-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 N GREEN ST STE 200",
            "city": "BROWNSBURG",
            "state": "IN",
            "postal_code": "461122417",
            "telephone_number": "317-386-5628",
            "fax_number": "317-386-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRICKS COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENDRICKS COUNTY HOSPITAL",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "RUTHERFORD",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "317-837-5566"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREEN ST FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brownsburg, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.