NPIMap

Organization Active NPI

St. Vincent Health Wellness and Preventive Care Institute, Inc.

Doing business as Ascension St. Vincent Public Safety Medical

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1609347210
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X
Legal business name
ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.
Doing business as
Ascension St. Vincent Public Safety Medical
Ascension St. Vincent Wellness
Practice address
6612 E 75TH St
Indianapolis, IN 46250-2875
Phone
(317) 964-2324
NPI assigned
Dec 7, 2018
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Brian Morris
Title
Cfo
Phone
(317) 338-6234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X NU Primary

Addresses

Primary practice location

6612 E 75TH St
Indianapolis, IN 46250-2875

Mailing address

250 W 96TH St # 520
Indianapolis, IN 46260-1316

Other names 2

  • Ascension St. Vincent Public Safety Medical Doing business as
  • Ascension St. Vincent Wellness Doing business as

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
15D1105207Ascension Medical Group St Vincent - Public6612 E 75TH St, Indianapolis, IN 46250Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ascension St Vincent Wellness22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

6612 E 75th St
Indianapolis, IN 46250
Phone (317) 972-1180

NPI Registry JSON

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

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1609347210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 96TH ST # 520",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6612 E 75TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502875",
            "telephone_number": "317-964-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-07",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-338-6234"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent Public Safety Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ascension St. Vincent Wellness",
            "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 Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.