NPIMap

Organization Active NPI

Premise Health of Indiana Medical, P.C.

Doing business as Family Health and Wellness Center

  • Primary Care Clinic/Center
  • Jamestown, IN
National Provider Identifier
1356925259
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PREMISE HEALTH OF INDIANA MEDICAL, P.C.
Doing business as
Family Health and Wellness Center
Practice address
1100 N Lebanon St Ste 2
Jamestown, IN 46147-9381
Phone
(765) 577-5900
Fax
(765) 577-5932
NPI assigned
May 7, 2021
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Authorized official

Name
Dr. Jon Leizman, MD
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

1100 N Lebanon St Ste 2
Jamestown, IN 46147-9381

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • Family Health and Wellness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Indiana Medical PC26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1100 N Lebanon St
Ste 2
Jamestown, IN 46147
Phone (765) 577-5900

NPI Registry JSON

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1356925259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N LEBANON ST STE 2",
            "city": "JAMESTOWN",
            "state": "IN",
            "postal_code": "461479381",
            "telephone_number": "765-577-5900",
            "fax_number": "765-577-5932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF INDIANA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-07",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jamestown, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.