Active NPI
American Health Network of Indiana, LLC
- Surgery Physician
- Kokomo, IN
National Provider Identifier
1609968858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
- Practice address
- 2343 W. Lincoln Road
Kokomo, IN 46902 - Phone
- (765) 455-4090
- Fax
- (765) 455-4091
- NPI assigned
- Sep 28, 2006
- Last updated
- Oct 29, 2007
- Organization subpart
- Yes
- Parent organization
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ben H Park, MD
- Title
- President and Ceo
- Phone
- (317) 580-6307
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
2343 W. Lincoln Road
Kokomo, IN 46902
Mailing address
2343 W. Lincoln Road
Kokomo, IN 46902
Phone (765) 455-4090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CH1052 | Other | IN | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031124000691 | IN | Part B Supplier - Clinic/Group Practice | 9830093533 |
Receives reassigned benefits from 230 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Ahn Georgetown
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1193616000000",
"number": "1609968858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2343 W. LINCOLN ROAD",
"city": "KOKOMO",
"state": "IN",
"postal_code": "46902",
"telephone_number": "765-455-4090",
"fax_number": "765-455-4091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2343 W. LINCOLN ROAD",
"city": "KOKOMO",
"state": "IN",
"postal_code": "46902",
"telephone_number": "765-455-4090",
"fax_number": "765-455-4091"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMERICAN HEALTH NETWORK OF INDIANA, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AMERICAN HEALTH NETWORK OF INDIANA, LLC",
"enumeration_date": "2006-09-28",
"last_updated": "2007-10-29",
"status": "A",
"authorized_official_last_name": "PARK",
"authorized_official_first_name": "BEN",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "PRESIDENT AND CEO",
"authorized_official_telephone_number": "317-580-6307",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CH1052",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kokomo, IN
- Clarence Bonoan Amayun, M.D.
- Nathan Clarence Amayun
- Amedisys Hospice, LLC (Amedisys Hospice)
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; 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.