NPIMap

Organization Active NPI

CHS Indiana Medical, P.C.

  • General Practice Physician
  • West Lafayette, IN
National Provider Identifier
1306196282
Registry record updated Aug 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CHS INDIANA MEDICAL, P.C.
Practice address
1400 W State St
West Lafayette, IN 47906-3438
Phone
(703) 760-0700
NPI assigned
Sep 18, 2012
Organization subpart
Yes
Parent organization
CHS HEALTH SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2016

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

Authorized official

Name
Stuart Clark
Title
Executive VP
Phone
(615) 577-5890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1400 W State St
West Lafayette, IN 47906-3438

Mailing address

5500 Maryland Way Ste 400
Brentwood, TN 37027-4948

Other names 1

  • The Center for Healthy Living Doing business as

National Provider Directory

National Provider Directory
Part of
Google Wellness Center 321

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1306196282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W STATE ST",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479063438",
            "telephone_number": "703-760-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHS INDIANA MEDICAL, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHS HEALTH SERVICES, LLC",
        "enumeration_date": "2012-09-18",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "EXECUTIVE VP",
        "authorized_official_telephone_number": "615-577-5890"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Center for Healthy Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.