Open Door Health Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Hartford City, IN
NPI 1245094028 · NPPES record last updated Feb 12, 2024
Key facts
- NPI
- 1245094028
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OPEN DOOR HEALTH SERVICES, INC.
- Practice address
- 410 Pilgrim Blvd
Hartford City, IN 47348-1382 - Phone
- (765) 286-7000
- Fax
- (765) 213-2769
- NPI assigned
- Feb 12, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- OPEN DOOR HEALTH SERVICES, INC.
Authorized official
- Name
- Bryan Ayars
- Title
- President
- Phone
- (765) 286-7000
Owners & managing parties with NPI records 7
Owned or controlled facilities with NPI records 3
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 8
Facilities with the same owner 3
Practitioners 176
-
Catherine Bryce Baugher, FNP-BC
-
Carrie F Bonsack, CNM
-
Randy K. Brown, MD
-
Katlyn Danielle Corpe, FAMILY NP
-
Melanie Hamlin, NP
-
Max H Rudicel, MD
-
Eric Collins, PHD
-
Connor Patrick Doherty, PA-C, ATC
-
Erika A Dunn, NP
-
Deanna Elleman, FNP-BC, MSN, BSN, RN
-
Abigail Falloon, FNP
-
Victoria Foerster, LMHC
-
Andrew Goul, D.C.
-
Shereene Grant, M.D.
-
Teresa Grizzle, NP
-
Kendrick Kwoczalla, LMHC
-
Nicholas Alexander Lee, PHD, HSPP
-
Katherine Claire Mack, LMHC
-
Cory N Matters, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Federally qualified health center certification: CCN C51032
- Legal name
- OPEN DOOR HEALTH SERVICES INC
- Doing business as
- OPEN DOOR HEALTH SERVICES BLACKFORD COUNTY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 26, 2024
- Last certification
- Apr 26, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 24, 1997 in IN
- Enrollment address
- 410 Pilgrim Blvd
Hartford City, IN 47348-1382
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Allen Johnstone |
Corporate Director |
Apr 18, 2019 | |
| Susan Dillon |
Corporate Director |
Mar 25, 2020 | |
| Patricia Kennedy |
Corporate Director |
Apr 18, 2019 | |
| Jeff Huff |
Corporate Director |
Apr 18, 2019 | |
| Open Door Health Services Inc |
5% Or Greater Direct Ownership Interest | May 1, 2024 | 100% |
| Jennifer Parks-Strack |
Corporate Director |
Jan 20, 2021 | |
| Michelle a Altobella |
Corporate Director |
May 1, 2024 | |
| Jean Marie Place |
Corporate Director |
Oct 7, 2020 | |
| Kenyonta Hudson |
Corporate Director |
Apr 18, 2019 | |
| Bryan W Ayars |
Corporate Officer |
Jun 1, 2016 | 100% |
| Operational/Managerial Control |
Jun 1, 2016 | 100% | |
| Kathy L Vermeulen |
Corporate Director |
Nov 21, 2019 | |
| Annette Craycraft |
Corporate Director |
Sep 18, 2019 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Open Door Pediatrics and Family Medicine |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2018 |
| Open Door School-Based Health |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Mar 24, 1997 |
| Open Door Health Services YMCA |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040115000592 | IN | Part B Supplier - Clinic/Group Practice | 5890696603 |
Receives reassigned benefits from 58 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Muncie, IN; Hartford City, IN; Anderson, IN |
| O20240510000259 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 5890696603 | Practice locations: Hartford City, IN |
National Provider Directory
- Tax ID family
- Open Door BMH Health Center
- Part of
- Open Door BMH Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
410 Pilgrim Blvd
Hartford City, IN 47348-1382
Mailing address
PO Box 1676
Muncie, IN 47308-1676
Phone (765) 286-7000
Other names
- Open Door Health Services Blackford County
Other providers in Hartford City, IN
- Midwest Healthstrategies, Inc.
- Malisha Dawn Morris
- National Mentor Healthcare, LLC
- Felicity Mae New
- Rachael Anne Olufowote
- Kaitlyn Marie Ort
- Caroline Poland
- Preferred Physicians PC
- Allyson Y Price
- R Matthew Maddox Dentistry, LLC
All providers in Hartford City, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.