Independence Healthcare LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

INDEPENDENCE HEALTHCARE LLC

Practice address

4595 Walnut Rd Ste L
Buckeye Lake, OH 43008-7909

Phone

(740) 822-0080

Fax

(740) 822-0081

NPI assigned

Oct 12, 2023

Organization subpart

No

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

Authorized official

Name

Khadie Muriel Thomas, DNP, FNP-BCNPI 1831679612

Title

Nurse Practitioner

Phone

(614) 893-6800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 2

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

• Khadie Thomas, CNP

  • Family Nurse Practitioner
  • Reynoldsburg, OH
  • NPI 1831679612
  Medicare reassignment NPD Authorized official
• Clara Pieh

  • Psychiatric/Mental Health Nurse Practitioner
  • Buckeye Lake, OH
  • NPI 1720255961
  NPD

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

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720137600000",
    "number": "1699556746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4595 WALNUT RD STE L",
            "city": "BUCKEYE LAKE",
            "state": "OH",
            "postal_code": "430087909",
            "telephone_number": "740-822-0080",
            "fax_number": "740-822-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4595 WALNUT RD STE L",
            "city": "BUCKEYE LAKE",
            "state": "OH",
            "postal_code": "430087909",
            "telephone_number": "740-822-0080",
            "fax_number": "740-822-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-12",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "KHADIE",
        "authorized_official_middle_name": "MURIEL",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "614-893-6800",
        "authorized_official_credential": "DNP, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Ziadeh
• Sandra Dawn Facemire, MSW, LISW-S
• Emily J Gilgien
• Colin J Golian, DDS
• Julia Hill-Byrd, DNP, APRN, PMHNP
• Bobbie Lester, MASSAGE THERAPIST
• Christina Elaine Lucas
• William Michael McKenzie, LPN
• Clara Pieh
• Stephanie Ann Porter

• Clinic/Center in Buckeye Lake, OH
• Providers in Buckeye Lake, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.