NPIMap

Organization Active NPI

Raphael Health Center, Inc

Doing business as Raphael Health Center Pharmacy

  • Pharmacy
  • Indianapolis, IN
National Provider Identifier
1194582221
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
RAPHAEL HEALTH CENTER, INC
Doing business as
Raphael Health Center Pharmacy
Practice address
401 E 34TH St
Indianapolis, IN 46205-3754
Phone
(317) 926-1507
NPI assigned
Mar 5, 2024
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
RAPHAEL HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Dr. Megan Elizabeth Conklin, PHARMD, MPH
Title
Pharmacist
Phone
(920) 912-7029

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary
Clinic Pharmacy 3336C0002X NU
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

401 E 34TH St
Indianapolis, IN 46205-3754

Mailing address

401 E 34TH St
Indianapolis, IN 46205-3754
Phone (317) 926-1507

Other names 1

  • Raphael Health Center Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240920001563 IN Part B Supplier - Pharmacy 4486562659 Practice locations: Indianapolis, IN

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Raphael Health Center2 organizations share this tax ID, including this one
Part of
Raphael Health Center

Other organizations with this tax ID 1

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

Locations

3401 N Meridian St
#108
Indianapolis, IN 46208
Phone (317) 926-1507

3445 Central Ave
Rm 7
Indianapolis, IN 46205
Phone (317) 266-4248

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FDCGDD

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Raphael Health Center IncIndianapolis, IN, CCN 151197 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 18, 1994

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1194582221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E 34TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462053754",
            "telephone_number": "317-926-1507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 34TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462053754",
            "telephone_number": "317-926-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAPHAEL HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RAPHAEL HEALTH CENTER, INC",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "CONKLIN",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "920-912-7029",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD, MPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raphael Health Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.