NPIMap

Organization Active NPI

Indiana Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • South Bend, IN
National Provider Identifier
1174626014
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INDIANA HEALTH CENTERS, INC.
Practice address
1901 W Western Ave, Ste B
South Bend, IN 46619-3521
Phone
(574) 234-9033
Fax
(574) 847-7200
NPI assigned
Sep 6, 2006
Last updated
Mar 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Authorized official

Name
Mr. Tracy Nagel
Title
Chief Financial Officer
Phone
(317) 576-1335

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1901 W Western Ave, Ste B
South Bend, IN 46619-3521

Mailing address

8003 Castleway Dr
Indianapolis, IN 46250-1946
Phone (317) 576-1335

Other names 1

  • Indiana Health Center @ South Bend Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061114000299 IN Part A Provider - Federally Qualified Health Center (FQHC) 3971599473 1 other NPI on this enrollment
Practice locations: South Bend, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174626014. Details of each certification follow.

Federally qualified health center certification: CCN 151806

Legal name
INDIANA HEALTH CENTERS INC
Doing business as
IHC AT SOUTH BEND
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 29, 1981 in IN
Enrollment address
1901 W Western Ave
Ste B
South Bend, IN 46619-3570

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Indiana Health Centers Inc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rebekah Price Individual Corporate DirectorBoard Member Jan 21, 2025
Brian P Kelly Individual Corporate DirectorBoard Member Sep 26, 2015
Earl H Lane Individual Corporate DirectorBoard Member Apr 10, 2011
Ann Lundy Individual Corporate OfficerCeo Jan 21, 2025
W-2 Managing EmployeeCeo Jan 21, 2025
Michael D Busch Individual Corporate DirectorBoard Member Sep 24, 1996
Addison G Haynes Individual Corporate OfficerCmo Feb 4, 2026
W-2 Managing EmployeeCmo Feb 4, 2026
Nicole Meyer Individual Corporate OfficerChief Operations Officer Sep 1, 2019
Tracy J Nagel Individual Corporate OfficerChief Financial Officer Jun 2, 2008
Tamara L Habegger Individual Corporate DirectorBoard Member Mar 28, 2015
David McDonald Individual Corporate DirectorBoard Member Sep 24, 2016
Ayotade Ojutalayo Individual Corporate DirectorBoard Member Oct 1, 2012
Maricela Navarro Individual Corporate DirectorBoard Member Aug 24, 2019
Andrea R Graham Individual Corporate DirectorBoard Member Jun 27, 2015
Bernard J Emkes Individual Corporate DirectorBoard Member Jun 4, 2003

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1174626014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "317-576-1335",
            "fax_number": "317-576-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W WESTERN AVE, STE B",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466193521",
            "telephone_number": "574-234-9033",
            "fax_number": "574-847-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "NAGEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "317-576-1335",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Health Center @ South Bend",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Indiana Health Center @ South Bend",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.