NPIMap

Organization Active NPI

Citizens Health Corporation

  • Community Health Clinic/Center
  • Indianapolis, IN
National Provider Identifier
1689653982
Registry record updated Dec 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CITIZENS HEALTH CORPORATION
Doing business as
CITIZENS HEALTH
Practice address
1650 N College Ave
Indianapolis, IN 46202-1715
Phone
(317) 924-6351
Fax
(317) 927-3634
NPI assigned
Jan 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2012

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

Authorized official

Name
Mr. Ron Gibson
Title
Ceo
Phone
(317) 396-0279

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary
Federally Qualified Health Center (FQHC) 261QF0400X 50000856A IN
Clinic Pharmacy 3336C0002X 60003640A IN

Addresses

Primary practice location

1650 N College Ave
Indianapolis, IN 46202-1715

Mailing address

1650 N College Ave
Indianapolis, IN 46202-1715
Phone (317) 924-6351

Other identifiers 4

IdentifierTypeStateIssuer
100196020BMedicaidIN
1524758OtherNCPDP PROVIDER IDENTIFICATION NUMBER
100196020AMedicaidIN
100297090AMedicaidIN

Other names 1

  • CITIZENS HEALTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 151812

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CITIZENS HEALTH CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1993
Last certification
Jun 1, 1993
Ownership / control type
For profit – partnership
Facility address
1650 N College Ave
Indianapolis, IN 46202

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356566400000",
    "number": "1689653982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 N COLLEGE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021715",
            "telephone_number": "317-924-6351",
            "fax_number": "317-927-3634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 N COLLEGE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021715",
            "telephone_number": "317-924-6351",
            "fax_number": "317-927-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2012-12-27",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "317-396-0279",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IN",
            "license": "50000856A",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "IN",
            "license": "60003640A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100196020B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1524758",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100196020A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100297090A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITIZENS HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.