NPIMap

Organization Active NPI

Hendricks County Hospital

Doing business as Lizton Family Medicine

  • Family Medicine Physician
  • Lizton, IN
National Provider Identifier
1710084025
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HENDRICKS COUNTY HOSPITAL
Doing business as
Lizton Family Medicine
Practice address
1045 Wyatt Way
Lizton, IN 46149
Phone
(317) 994-6600
Fax
(317) 994-6605
NPI assigned
Sep 20, 2006
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
Heather Rutherford
Title
Credentialing Coordinator
Phone
(317) 837-5566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1045 Wyatt Way
Lizton, IN 46149

Mailing address

1100 Southfield Dr
Suite 1370
Plainfield, IN 46168-4498
Phone (317) 837-5571

Other names 1

  • Lizton Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040811000309 IN Part B Supplier - Clinic/Group Practice 4880505528 Receives reassigned benefits from 431 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Brownsburg, IN; Danville, IN; Greencastle, IN; Lizton, IN; Plainfield, IN; Avon, IN; Bainbridge, IN

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
15D1058657Lizton Family Medicine1045 Wyatt Way, Lizton, IN 46149Certificate of waiverDec 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hendricks County Hospital110 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member organizations 7

Organizations listed as members of this organization in the National Provider Directory.

Locations

1152 E US Highway 36
Bainbridge, IN 46105
Phone (765) 522-1889

100 Hospital Ln
Ste 105
Danville, IN 46122
Phone (317) 745-3333

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1710084025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SOUTHFIELD DR",
            "address_2": "SUITE 1370",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461684498",
            "telephone_number": "317-837-5571",
            "fax_number": "317-837-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 WYATT WAY",
            "city": "LIZTON",
            "state": "IN",
            "postal_code": "46149",
            "telephone_number": "317-994-6600",
            "fax_number": "317-994-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRICKS COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "RUTHERFORD",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "317-837-5566"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lizton Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lizton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.