Indiana Health Centers, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Seymour, IN
NPI 1124434469 · NPPES record last updated Mar 17, 2023
Key facts
- NPI
- 1124434469
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- INDIANA HEALTH CENTERS, INC
- Practice address
- 120 Saint Louis Ave
Seymour, IN 47274-2304 - Phone
- (812) 405-1857
- Fax
- (844) 397-1315
- NPI assigned
- Jul 8, 2014
- Organization subpart
- No
Authorized official
- Name
- Mr. Tracy J Nagel
- Title
- Cfo
- Phone
- (317) 576-1335
Owners & managing parties with NPI records 1
-
Addison G Haynes, DO
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 21
Practitioners 68
-
Mackenzie Elise Binkley, LCSW
-
Vaishali Karnik, MD
-
Tabitha Dawn Pena, FNP-C
-
Lisa Achenbach, NP
-
Alexander Allison, LCSW
-
John R. Anderson, MA
-
Leigh Anderson, FNP-C
-
Megan L Catt, FNP-C
-
Elizabeth Dulmes, N.P.
-
Jodi Durst, FNP
-
Kristina K Glick, RN
-
Amber Gonzales, LCSW
-
Robert Joseph Hammerling, D.C.
-
Addison G Haynes, DO
-
Jay Lee Hoeksema, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Federally qualified health center certification: CCN 151937
- Legal name
- INDIANA HEALTH CENTERS INC
- Doing business as
- CHCJC ANNEX
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 27, 2014
- Last certification
- Oct 27, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 120 Saint Louis Ave
Seymour, IN 47274-2304
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Rebekah Price |
Corporate Director |
Feb 29, 2020 | |
| Brian P Kelly |
Corporate Director |
Sep 26, 2015 | |
| Earl H Lane |
Corporate Director |
Apr 10, 2011 | |
| Ann Lundy |
Corporate Officer |
Jan 30, 2025 | |
| W-2 Managing Employee |
Jan 30, 2025 | ||
| Michael D Busch |
Corporate Director |
Sep 24, 1996 | |
| Addison G Haynes |
Corporate Officer |
Feb 4, 2026 | |
| W-2 Managing Employee |
Feb 4, 2026 | ||
| Nicole Meyer |
Corporate Director |
Aug 1, 2020 | |
| Tracy J Nagel |
Corporate Officer |
Jun 2, 2008 | |
| Tamara L Habegger |
Corporate Director |
Mar 28, 2015 | |
| David McDonald |
Corporate Director |
Sep 24, 2016 | |
| Ayotade Ojutalayo |
Corporate Director |
Oct 1, 2012 | |
| Maricela Navarro |
Corporate Director |
Aug 24, 2019 | |
| Andrea R Graham |
Corporate Officer |
Jun 27, 2015 | |
| Bernard J Emkes |
Corporate Director | Jun 6, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141016000443 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 3971599473 | Practice locations: Seymour, IN |
National Provider Directory
- Tax ID family
- Indiana Health Centers
Locations
3118 S Lafountain St
Kokomo, IN 46902
Phone (765) 864-4160
3710 S Western Ave
Marion, IN 46953
Phone (765) 263-8577
120 Saint Louis Ave
Seymour, IN 47274
Phone (812) 405-1857
1010 N Bendix Dr
South Bend, IN 46628
Phone (574) 245-4980
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
120 Saint Louis Ave
Seymour, IN 47274-2304
Mailing address
8003 Castleway Dr
Indianapolis, IN 46250-1946
Phone (317) 576-1335
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100071250 | Medicaid | IN |
Other names
- CHCJC ANNEX
Other providers in Seymour, IN
- David Huehls
- Marion Huff
- Ngozi Igboko
- Nwadi Vanessa Nkiru Ada Igwe
- Greg Inabnit
- Indiana Health Centers, Inc.
- Indiana Health Centers, Inc. Pharmacy LLC
- Dale J Isaacs
- Joyce Renee Iwema
- J Mark Thomas DDS PC
All providers in Seymour, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.