NPIMap

Organization Active NPI

State of Indiana Auditor of State

Doing business as Indiana Department of Health Laboratories

  • Clinical Medical Laboratory
  • Indianapolis, IN
National Provider Identifier
1194033092
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
15D0662599 Issued in IN
Legal business name
STATE OF INDIANA AUDITOR OF STATE
Doing business as
Indiana Department of Health Laboratories
Indiana State Department of Health
Practice address
550 W 16TH St Ste B
Indianapolis, IN 46202-2218
Phone
(317) 921-5500
Fax
(317) 924-7801
NPI assigned
Sep 14, 2010
Last updated
Oct 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Authorized official

Name
Dr. Lixia Liu, PHD, D(ABMM)
Title
Asst CMMR & State Lab Director
Phone
(317) 921-5832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 15D0662599 IN Primary

Addresses

Primary practice location

550 W 16TH St Ste B
Indianapolis, IN 46202-2218

Mailing address

550 W 16TH St Ste B
Indianapolis, IN 46202-2218
Phone (317) 921-5500

Other identifiers 2

IdentifierTypeStateIssuer
100284680AMedicaidIN
100284680MedicaidIN

Other names 2

  • Indiana Department of Health Laboratories Doing business as
  • Indiana State Department of Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140801001493 IN Part B Supplier - Independent Clinical Laboratory 1759280118 Practice locations: Indianapolis, IN

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Indiana State Department of32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Neurodiagnostic InstituteIndianapolis, IN, CCN 154008 Hospital Operational/Managerial Control (100%) Sep 16, 2015
Evansville State HospitalEvansville, IN, CCN 154056 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 22, 2010
Madison State HospitalMadison, IN, CCN 154019 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
Richmond State HospitalRichmond, IN, CCN 154018 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Indiana Veterans HomeWest Lafayette, IN, CCN 155787 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 21, 2011

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1194033092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W 16TH ST STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022218",
            "telephone_number": "317-921-5500",
            "fax_number": "317-924-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W 16TH ST STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022218",
            "telephone_number": "317-921-5500",
            "fax_number": "317-924-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF INDIANA AUDITOR OF STATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-14",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "LIXIA",
        "authorized_official_title_or_position": "ASST CMMR & STATE LAB DIRECTOR",
        "authorized_official_telephone_number": "317-921-5832",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, D(ABMM)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "15D0662599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100284680A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100284680",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Department of Health Laboratories",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Indiana State Department of Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.