NPIMap

Organization Active NPI

Paradigm Living Concepts, LLC

  • Gerontology Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1679194773
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
PARADIGM LIVING CONCEPTS, LLC
Practice address
8904 Bash St Ste B
Indianapolis, IN 46256-1286
Phone
(317) 735-6001
NPI assigned
Apr 29, 2020
Last updated
Apr 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Authorized official

Name
Jeffrey Noah Jarecki, MBA/ HFA
Title
President & Ceo
Phone
(317) 735-6001

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Case Management Registered Nurse 163WC0400X
Licensed Practical Nurse 164W00000X
Geriatric Medicine (Family Medicine) Physician 207QG0300X
Nurse Practitioner 363L00000X
Gerontology Nurse Practitioner 363LG0600X Primary
Case Manager/Care Coordinator 171M00000X
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X

Addresses

Primary practice location

8904 Bash St Ste B
Indianapolis, IN 46256-1286

Mailing address

8904 Bash St Ste B
Indianapolis, IN 46256-1286
Phone (317) 735-6001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131113001498 IN Part B Supplier - Clinic/Group Practice 1355575424 Receives reassigned benefits from 27 practitioners
1 other NPI on this enrollment
Practice locations: Indianapolis, IN

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Paradigm Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

8904 Bash St
Indianapolis, IN 46256

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1679194773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8904 BASH ST STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561286",
            "telephone_number": "317-735-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8904 BASH ST STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561286",
            "telephone_number": "317-735-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADIGM LIVING CONCEPTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "JARECKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "NOAH",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "317-735-6001",
        "authorized_official_credential": "MBA/ HFA"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 29, 2020; 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.