NPIMap

Organization Active NPI

Open Door Health Services, Inc.

Doing business as Open Door School-Based Health

  • Federally Qualified Health Center (FQHC)
  • Muncie, IN
National Provider Identifier
1144974155
Registry record updated Feb 8, 2022
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.
Doing business as
Open Door School-Based Health
Practice address
801 N Walnut St
Muncie, IN 47305-1458
Phone
(765) 286-7000
NPI assigned
Feb 8, 2022
Last updated
Feb 8, 2022By 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 Feb 8, 2022

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

Authorized official

Name
Marie Burkey
Title
VP-Compliance/Risk
Phone
(765) 286-7000

Specialties & licenses 1

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

Addresses

Primary practice location

801 N Walnut St
Muncie, IN 47305-1458

Mailing address

333 S Madison St
Muncie, IN 47305-2465

Other names 1

  • Open Door School-Based Health Doing business as

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
O20220311000484 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 1144974155. Details of each certification follow.

Federally qualified health center certification: CCN 151135

Legal name
OPEN DOOR HEALTH SERVICES INC
Doing business as
OPEN DOOR SCHOOL-BASED HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2022
Last certification
Mar 11, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1997 in IN
Enrollment address
801 N Walnut St
Muncie, IN 47305-1458

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.

National Provider Directory

National Provider Directory
Tax ID family
Open Door Health Services9 organizations share this tax ID, including this one
Part of
Open Door Health Services

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

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
Susan Dillon Individual Corporate DirectorBoard Member Mar 25, 2020
Patricia Kennedy Individual Corporate DirectorBoard Member Apr 18, 2019
Jeff Huff Individual Corporate DirectorBoard Member Apr 18, 2019
Open Door Health Services Inc Organization, Muncie, IN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 24, 1997 100%
Jennifer Parks-Strack Individual Corporate DirectorBoard Member Apr 18, 2019
Michelle a Altobella Individual Corporate DirectorBoard Member Apr 18, 2019
Glenn E Stone 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 OfficerCeo Feb 1, 2022
W-2 Managing EmployeeCeo Feb 1, 2022 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 Pediatrics and Family MedicineMuncie, IN, CCN 151046 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2018
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 1

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": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1144974155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S MADISON ST",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473052465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N WALNUT ST",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473051458",
            "telephone_number": "765-286-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR HEALTH SERVICES, INC.",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "BURKEY",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "VP-COMPLIANCE/RISK",
        "authorized_official_telephone_number": "765-286-7000"
    },
    "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": "Open Door School-Based Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muncie, IN

Sources for this page

Verify at the official NPI Registry.