NPIMap

Organization Active NPI

Community Hospitals of Indiana Inc

Doing business as Shadeland Family Care Center

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1477626398
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY HOSPITALS OF INDIANA INC
Doing business as
Shadeland Family Care Center
Practice address
2040 N Shadeland Ave
Suite 300
Indianapolis, IN 46219-1711
Phone
(317) 355-3232
Fax
(317) 355-6042
NPI assigned
Nov 16, 2006
Last updated
Oct 13, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HOSPITALS OF INDIANA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

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

Authorized official

Name
Jeffery Kirkham
Title
Cfo
Phone
(317) 355-4887

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

2040 N Shadeland Ave
Suite 300
Indianapolis, IN 46219-1711

Mailing address

3826 Solutions Ctr
Chicago, IL 60677-3008
Phone (317) 355-5837

Other identifiers 4

IdentifierTypeStateIssuer
000000107139OtherINANTHEM
5942684OtherINAETNA
100121170AMedicaidIN
000000226100OtherINANTHEM

Other names 1

  • Shadeland Family Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000554 IN Part B Supplier - Clinic/Group Practice 1850203977 Receives reassigned benefits from 282 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indianapolis, IN; Greenfield, IN; Kokomo, IN; Shelbyville, IN; Greenwood, IN; Anderson, IN

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Part of
David Felkins MD

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1477626398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3826 SOLUTIONS CTR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606773008",
            "telephone_number": "317-355-5837",
            "fax_number": "317-355-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 N SHADELAND AVE",
            "address_2": "SUITE 300",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462191711",
            "telephone_number": "317-355-3232",
            "fax_number": "317-355-6042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITALS OF INDIANA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HOSPITALS OF INDIANA INC",
        "enumeration_date": "2006-11-16",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "KIRKHAM",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-355-4887"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000107139",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5942684",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100121170A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000226100",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadeland Family Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.