NPIMap

Organization Active NPI

Privia Medical Group Indiana, LLC

  • Multi-Specialty Clinic/Center
  • Elkhart, IN
National Provider Identifier
1215567003
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PRIVIA MEDICAL GROUP INDIANA, LLC
Practice address
2117 W Lexington Ave
Elkhart, IN 46514-1423
Phone
(574) 296-3444
Fax
(574) 296-3328
NPI assigned
Jan 21, 2020
Organization subpart
Yes
Parent organization
ELKHART CLINIC, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Authorized official

Name
Timothy Porsche, MD
Title
Managing Partner
Phone
(574) 296-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2117 W Lexington Ave
Elkhart, IN 46514-1423

Mailing address

PO Box 2968
Elkhart, IN 46515-2968
Phone (574) 296-3200

Other names 1

  • Elkhart Clinic Hematology and Oncology Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000052 IN Part B Supplier - Clinic/Group Practice 2365341674 Receives reassigned benefits from 46 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elkhart, IN; Wakarusa, IN; Mishawaka, IN

National Provider Directory

National Provider Directory
Tax ID family
Elkhart Clinic5 organizations share this tax ID, including this one
Part of
Elkhart Clinic

Other organizations with this tax ID 4

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

Locations

2117 W Lexington Ave
Elkhart, IN 46514
Phone (574) 296-3255

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Other NPIs on the same Medicare enrollment 8

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

NPI Registry JSON

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1215567003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152968",
            "telephone_number": "574-296-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 W LEXINGTON AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141423",
            "telephone_number": "574-296-3444",
            "fax_number": "574-296-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP INDIANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELKHART CLINIC, LLC",
        "enumeration_date": "2020-01-21",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "PORSCHE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "574-296-3200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elkhart Clinic Hematology and Oncology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Elkhart Clinic Hematology and Oncology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.