Fundamental Health, Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FUNDAMENTAL HEALTH, INC

Practice address

1221 S Creasy LN Ste K3
Lafayette, IN 47905-7430

Phone

(765) 838-2310

Fax

(765) 838-1035

NPI assigned

Nov 13, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Julie Christine Miranda, LPN

Title

Practice Manager

Phone

(765) 838-2310

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 3

Practitioners 1

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

• Courtney Boswell, FNP

  • Family Nurse Practitioner
  • Westfield, IN
  • NPI 1730650581
  NPD (past)

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

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614297600000",
    "number": "1114529237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S CREASY LN STE K3",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479057430",
            "telephone_number": "765-838-2310",
            "fax_number": "765-838-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 S CREASY LN STE K3",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479057430",
            "telephone_number": "765-838-2310",
            "fax_number": "765-838-1035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "412 E Southway Blvd",
            "address_purpose": "LOCATION",
            "city": "Kokomo",
            "state": "IN",
            "postal_code": "469023814",
            "country_code": "US",
            "telephone_number": "765-252-0453",
            "fax_number": "765-865-8070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1221 South Creasy",
            "address_2": "Suite K3",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "47905",
            "country_code": "US",
            "telephone_number": "812-269-1084",
            "fax_number": "812-287-8518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FUNDAMENTAL HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "MIRANDA",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "765-838-2310",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1942753082",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEN'S HEALTH",
            "identifier": "1114529237",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1659312759",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Kareo",
            "affiliation": "N",
            "address_1": "1221 S Creasy Ln Ste K3",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479057430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "765-838-2310",
            "affiliation": "N",
            "endpointDescription": "fax machine",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1221 S Creasy Ln Ste K3",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479057430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "juliemiranda@volonteman.com",
            "affiliation": "Y",
            "endpointDescription": "email",
            "affiliationName": "Indiana Wellness, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1221 S Creasy Ln Ste K3",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479057430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joseph Edward Fruland, MD
• Stefanie Fuller
• Kiera Fullerton
• Regina Lynn Fultz, MS, OTR
• David Fumo Jr., MD
• Shana K Funk, LMSW
• Linda S Furseth, MS, LPC
• Emily Ann Fusiek, BSN, RN
• Fve MW LLC
• FX Services of Lafayette, Inc.

• Internal Medicine Physician in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.