Longevity Clinical LTC Associates of Indiana, PC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

LONGEVITY CLINICAL LTC ASSOCIATES OF INDIANA, PC

Practice address

2640 Cold Spring Rd
Indianapolis, IN 46222-2272

Phone

(317) 923-1518

NPI assigned

Sep 10, 2024

Organization subpart

No

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

Authorized official

Name

Diane Vincur

Title

Manager

Phone

(561) 815-2427

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 6

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

• Donna M Gettle, FNP-C

  • Family Nurse Practitioner
  • Indianapolis, IN
  • NPI 1144950254
  Medicare reassignment NPD
• Rebecca Louise Koenig, FNP

  • Family Nurse Practitioner
  • Muncie, IN
  • NPI 1407308372
  Medicare reassignment NPD
• Lindsey D Robertson, NP

  • Medical Physician Assistant
  • Indianapolis, IN
  • NPI 1982039244
  Medicare reassignment NPD
• Connie Jo Tishner, FNP- C

  • Family Nurse Practitioner
  • Peru, IN
  • NPI 1629623392

  Primary Care

  Medicare reassignment NPD
• Brooke Michelle West, FNP-C

  • Family Nurse Practitioner
  • Muncie, IN
  • NPI 1003528639
  Medicare reassignment NPD
• Endia Cherese Johnson-Pitts, MD

  • Hospitalist Physician
  • Winston Salem, NC
  • NPI 1801819594
  NPD (past)

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1497581250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11780 US HIGHWAY 1 STE N107",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334083007",
            "telephone_number": "561-815-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 COLD SPRING RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462222272",
            "telephone_number": "317-923-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CLINICAL LTC ASSOCIATES OF INDIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "VINCUR",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-815-2427"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Long
• William Randall Long, D.D.S.
• Sarah J Longe, LCSW
• Jennifer Longenecker
• Diane Marie Longerbone, MA.,RD.,CD.
• Longevity Institute of Indiana,P.C.
• Jill Marie Longfellow, DPT
• Sarah J Longmire-Cook, MD
• Scott M Longmuir, PT, DPT, OCS, CSCS
• Sheila Marie Longpre, PTA

• Geriatric Medicine (Family Medicine) Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Geriatric Medicine (Family Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.