NPIMap

Organization Active NPI

Proactive Mso, LLC

Doing business as Proactive MD

  • Primary Care Clinic/Center
  • Crawfordsville, IN
National Provider Identifier
1174169908
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROACTIVE MSO, LLC
Doing business as
Proactive MD
Proactive MD Crawfordsville Chamber Health Center
Practice address
1720 Lafayette Rd Ste a
Crawfordsville, IN 47933-4603
Phone
(812) 645-1945
NPI assigned
Nov 27, 2019
Last updated
Mar 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

Name
Jan Hopkins
Title
Assoc. Ops MGR
Phone
(864) 501-0751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1720 Lafayette Rd Ste a
Crawfordsville, IN 47933-4603

Mailing address

124 Allawood CT
Simpsonville, SC 29681-6207
Phone (864) 501-0751

Other names 2

  • Proactive MD Doing business as
  • Proactive MD Crawfordsville Chamber Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Proactive Mso LLC35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

1720 Lafayette Rd
Ste A
Crawfordsville, IN 47933
Phone (765) 323-2828

NPI Registry JSON

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

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1174169908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 LAFAYETTE RD STE A",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479334603",
            "telephone_number": "812-645-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MSO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-27",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "ASSOC. OPS MGR",
        "authorized_official_telephone_number": "864-501-0751"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proactive MD Crawfordsville Chamber Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crawfordsville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; 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.