Ideal Health Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

IDEAL HEALTH CLINIC LLC

Practice address

3881 Eagle Creek Pkwy Ste a
Indianapolis, IN 46254-5600

Phone

(317) 730-3956

NPI assigned

May 4, 2023

Organization subpart

No

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

Authorized official

Name

Schani Manungo, NPNPI 1104175470

Title

Owner

Phone

(317) 730-3956

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Schani Manungo, NP-C

  • Family Nurse Practitioner
  • Indianapolis, IN
  • NPI 1104175470
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1235828385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3881 EAGLE CREEK PKWY STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545600",
            "telephone_number": "317-969-8332",
            "fax_number": "317-969-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3881 EAGLE CREEK PKWY STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545600",
            "telephone_number": "317-730-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "MANUNGO",
        "authorized_official_first_name": "SCHANI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-730-3956",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.