NPIMap

Organization Active NPI

Indiana Health Centers, Inc

Doing business as IHC Grant-Blackford

  • Federally Qualified Health Center (FQHC)
  • Marion, IN
National Provider Identifier
1215343389
Registry record updated Jul 7, 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
Doing business as
IHC Grant-Blackford
Practice address
116 E 32ND St Ste a
Marion, IN 46953-4060
Phone
(765) 664-7492
Fax
(765) 400-4466
NPI assigned
Jul 9, 2014
Last updated
Jul 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Mr. Tracy J Nagel
Title
Cfo
Phone
(317) 576-1335

Specialties & licenses 1

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

Addresses

Primary practice location

116 E 32ND St Ste a
Marion, IN 46953-4060

Mailing address

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

Other names 1

  • IHC Grant-Blackford Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040430001159 IN Part B Supplier - Clinic/Group Practice 3971599473 Receives reassigned benefits from 67 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spencer, IN; Indianapolis, IN; South Bend, IN; Peru, IN; Seymour, IN; Bedford, IN; Kokomo, IN; Marion, IN…
O20141105000240 IN Part A Provider - Federally Qualified Health Center (FQHC) 3971599473 Practice locations: Marion, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215343389. Details of each certification follow.

Federally qualified health center certification: CCN 151936

Legal name
INDIANA HEALTH CENTERS INC
Doing business as
IHC GRANT-BLACKFORD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 10, 2014
Last certification
Nov 10, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
116 E 32ND St
Ste a
Marion, IN 46953-4060

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 3

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

Locations

206 W 8th St
Marion, IN 46953
Phone (765) 293-0011

661 E Main St
Peru, IN 46970
Phone (765) 472-2519

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 Feb 29, 2020
Brian P Kelly Individual Corporate DirectorBoard Member Sep 26, 2015
Earl H Lane Individual Corporate DirectorBoard Member Jan 30, 2025
Ann Lundy Individual Corporate OfficerPresident/Ceo Jun 6, 2022
Michael D Busch Individual Corporate DirectorBoard Member Sep 24, 1996
Addison G Haynes Individual Corporate OfficerCmo Feb 4, 1986
W-2 Managing EmployeeCmo Feb 4, 1986
Nicole Meyer Individual Corporate OfficerCoo Aug 1, 2020
Tracy J Nagel Individual Corporate OfficerChief Financial Officer Jun 2, 2008
W-2 Managing EmployeeCfo Jan 1, 2023
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 2

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": "1404864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1215343389",
    "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": "116 E 32ND ST STE A",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469534060",
            "telephone_number": "765-664-7492",
            "fax_number": "765-400-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-09",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "NAGEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-576-1335",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "IHC Grant-Blackford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.