Healthy Aging Enterprise, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HEALTHY AGING ENTERPRISE, LLC

Practice address

10926 Belle Plaine Blvd
Fishers, IN 46037-7113

Phone

(317) 985-9501

NPI assigned

Feb 9, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Marwan Mustaklem, M.D.NPI 1750357513

Title

MBR

Phone

(317) 985-9501

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hancock Regional Hospital

  • Skilled Nursing Facility
  • Indianapolis, IN
  • NPI 1700291143

  Adp of the SNF

  CMS ownership

Practitioners 2

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

• Marwan A. Mustaklem

  • Internal Medicine Physician
  • Fishers, IN
  • NPI 1750357513
  Medicare reassignment Care Compare group NPD Authorized official
• Rona A. Abu Manneh, M.D.

  • Internal Medicine Physician
  • Fishers, IN
  • NPI 1548432511

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1417315102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10926 BELLE PLAINE BLVD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10926 BELLE PLAINE BLVD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377113",
            "telephone_number": "317-985-9501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY AGING ENTERPRISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "MUSTAKLEM",
        "authorized_official_first_name": "MARWAN",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "317-985-9501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Fishers, IN
• Providers in Fishers, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.