NPIMap

Organization Active NPI

Trustees of Purdue University

Doing business as Family Health Clinic of Carroll County

  • Federally Qualified Health Center (FQHC)
  • Delphi, IN
National Provider Identifier
1477549731
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRUSTEES OF PURDUE UNIVERSITY
Doing business as
Family Health Clinic of Carroll County
Practice address
901 Prince William Rd
Suite a
Delphi, IN 46923-1759
Phone
(765) 564-3016
Fax
(765) 564-2608
NPI assigned
Sep 22, 2005
Last updated
Jul 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PURDUE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Authorized official

Name
Mr. Daniel J. Layman
Title
Executive Director
Phone
(765) 564-3016

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X IN Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

901 Prince William Rd
Suite a
Delphi, IN 46923-1759

Mailing address

901 Prince William Rd Ste a
Delphi, IN 46923-1759
Phone (765) 564-3016

Other practice location 1

401 Armory Rd
Delphi, IN 46923-1906
Phone (765) 564-3016

Other practice location 2

2362 E State Road 18
Flora, IN 46929-8201
Phone (765) 564-3016

Other practice location 3

205 E Cumberland St
Camden, IN 46917-4108
Phone (765) 564-3016

Other practice location 4

300 W Vine St
Delphi, IN 46923-1651
Phone (765) 564-3016

Other practice location 5

301 Armory Rd
Delphi, IN 46923-1904
Phone (765) 564-3016

Other identifiers 1

IdentifierTypeStateIssuer
200233610AMedicaidIN

Other names 1

  • Family Health Clinic of Carroll County Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100208000590 IN Part A Provider - Federally Qualified Health Center (FQHC) 2567373012 Practice locations: Delphi, IN
O20200821001390 IN Part B Supplier - Clinic/Group Practice 2567373012 Receives reassigned benefits from 41 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burlington, IN; Delphi, IN; Monon, IN; West Lafayette, IN; Wolcott, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477549731. Details of each certification follow.

Federally qualified health center certification: CCN 151863

Legal name
TRUSTEES OF PURDUE UNIVERSITY
Doing business as
FAMILY HEALTH CLINIC OF CARROLL COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 10, 2010
Last certification
Feb 10, 2010
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
901 Prince William Rd
Ste a
Delphi, IN 46923-1759

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D1024482Family Health Clinic of Carroll County901 Prince William Rd Ste a, Delphi, IN 46923Provider-performed microscopyApr 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Purdue University Student19 organizations share this tax ID, including this one
Part of
Purdue University Student

Other organizations with this tax ID 18

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

View all 18

Locations

300 W Vine St
Delphi, IN 46923
Phone (765) 564-3895

2362 E State Road 18
Flora, IN 46929
Phone (574) 967-5100

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Trustees of Purdue University Organization, Wolcott, IN Non-profit 5% Or Greater Direct Ownership Interest Jan 7, 2010 100%
Elizabeth M Burrows Individual Corporate OfficerInterim Executive Director Oct 13, 2023
W-2 Managing EmployeeInterim Executive Director Oct 13, 2023
Operational/Managerial ControlInterim Executive Director Oct 13, 2023
Sherri Gehlhausen Individual Corporate OfficerDir. of Revenue Cycle Management Oct 13, 2023
W-2 Managing EmployeeDir. of Revenue Cycle Management Oct 13, 2023
Operational/Managerial ControlDir. of Revenue Cycle Management Oct 13, 2023

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Family Health Clinic of MononMonon, IN, CCN 151862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 30, 2018
Family Health Clinic of BurlingtonBurlington, IN, CCN 151966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 4, 2016
Family Health Clinic of WolcottWolcott, IN, CCN 151976 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 15, 2016

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 54

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1477549731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 PRINCE WILLIAM RD STE A",
            "city": "DELPHI",
            "state": "IN",
            "postal_code": "469231759",
            "telephone_number": "765-564-3016",
            "fax_number": "765-564-2608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 PRINCE WILLIAM RD",
            "address_2": "SUITE A",
            "city": "DELPHI",
            "state": "IN",
            "postal_code": "469231759",
            "telephone_number": "765-564-3016",
            "fax_number": "765-564-2608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Armory Rd",
            "address_purpose": "LOCATION",
            "city": "Delphi",
            "state": "IN",
            "postal_code": "469231906",
            "country_code": "US",
            "telephone_number": "765-564-3016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2362 E State Road 18",
            "address_purpose": "LOCATION",
            "city": "Flora",
            "state": "IN",
            "postal_code": "469298201",
            "country_code": "US",
            "telephone_number": "765-564-3016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 E Cumberland St",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "IN",
            "postal_code": "469174108",
            "country_code": "US",
            "telephone_number": "765-564-3016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 W Vine St",
            "address_purpose": "LOCATION",
            "city": "Delphi",
            "state": "IN",
            "postal_code": "469231651",
            "country_code": "US",
            "telephone_number": "765-564-3016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Armory Rd",
            "address_purpose": "LOCATION",
            "city": "Delphi",
            "state": "IN",
            "postal_code": "469231904",
            "country_code": "US",
            "telephone_number": "765-564-3016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRUSTEES OF PURDUE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PURDUE UNIVERSITY",
        "enumeration_date": "2005-09-22",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "LAYMAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "765-564-3016",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IN",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200233610A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Clinic of Carroll County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Health Clinic of Carroll County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Delphi, IN

Sources for this page

Verify at the official NPI Registry.