Active NPI
Tracey Williams
- Health Service Clinic/Center
- Indianapolis, IN
National Provider Identifier
1265063622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Clinic/Center
- Practice address
- 55 S State Ave
Indianapolis, IN 46201-3802 - Phone
- (317) 937-5732
- NPI assigned
- Feb 3, 2020
- Last updated
- Feb 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | NU | Primary |
Addresses
Primary practice location
55 S State Ave
Indianapolis, IN 46201-3802
Mailing address
541 Forest Ave
Greenwood, IN 46143-1744
Phone (317) 937-5732
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0460368345 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580688000000",
"number": "1265063622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "541 FOREST AVE",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461431744",
"telephone_number": "317-937-5732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 S STATE AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462013802",
"telephone_number": "317-937-5732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "TRACEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-03",
"last_updated": "2020-02-03",
"certification_date": "2020-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460368345",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.