GSG Pride Healthcare LLC
Organization Active NPI Primary Care Clinic/Center · Fortville, IN
NPI 1437622701 · NPPES record last updated Jul 28, 2026
Key facts
- NPI
- 1437622701
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- GSG PRIDE HEALTHCARE LLC
- Practice address
- 426 N Crystal Dr
Fortville, IN 46040-1688 - Phone
- (317) 743-0009
- NPI assigned
- Jan 9, 2019
- Organization subpart
- No
Authorized official
- Name
- Taris D Gonzalez, NP
- Title
- Nurse Practitioner/Owner
- Phone
- (317) 743-0009
Practitioners 1
-
Taris Gonzalez, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190312002841 | IN | Part B Supplier - Clinic/Group Practice | 7113267022 |
Receives reassigned benefits from 1 practitioner Practice locations: Pendleton, IN |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/18915/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
426 N Crystal Dr
Fortville, IN 46040-1688
Mailing address
426 N Crystal Dr
Fortville, IN 46040-1688
Phone (317) 743-0009
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821290743 | Medicaid | IN |
Other names
- Medical Practice
- Taris Gonzalez
Other providers in Fortville, IN
- Ann M Gang
- Garst RX LLC
- Eric Garst
- Taris Gonzalez
- Lacey Nichole Groce
- Jaclyn A Guglielmo
- Sajid Hameed
- Hancock Regional Hospital
- Harmony Dentistry of Fortville, LLC
- Amy Hayes
All providers in Fortville, IN · Primary Care Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2026. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.