Individual provider Active NPI

Grace Elizabeth Poduch, PA-C

  • Physician Assistant
  • Bloomington, IN
National Provider Identifier
1467329185
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10005102A Issued in IN
Practice address
463 S Park Ridge Rd Ste 101
Bloomington, IN 47401-8589
Phone
(812) 235-8496
NPI assigned
Oct 17, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10005102A IN Primary

Addresses

Primary practice location

463 S Park Ridge Rd Ste 101
Bloomington, IN 47401-8589

Mailing address

750 N Woodbridge Dr
Bloomington, IN 47408-2778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251222003225 IN Practitioner - Physician Assistant 2567957061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
HPW Center for Diabetes LLCGroup PAC ID 9537568993, 9 clinicians

Practice addresses (Care Compare)

463 S Park Ridge Rd
Suite 101
Bloomington, IN 47401-8589
Phone (812) 235-8496

Hospital & facility affiliations

  • Indiana University Health Bedford Hospital Hospital, Bedford, IN, CCN 151328
  • Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051
  • Greene County General Hospital Hospital, Linton, IN, CCN 151317

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10005102AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
HPW Center for Diabetes, LLC Endocrinology, Diabetes & Metabolism CurrentSince Dec 5, 2025 Accepting new patients
Providence Medical Group LLC PastSince Aug 1, 2004 Accepting new patients

Locations

463 S Park Ridge Rd
#101
Bloomington, IN 47401
Phone (812) 235-8496

2224 Lafayette Ave
Terre Haute, IN 47805
Phone (812) 235-8496

3560 S 4th St
Terre Haute, IN 47802
Phone (812) 235-8496

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1760659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1467329185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N WOODBRIDGE DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474082778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463 S PARK RIDGE RD STE 101",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018589",
            "telephone_number": "812-235-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODUCH",
        "first_name": "GRACE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-17",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005102A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.