NPIMap

Organization Active NPI

Indiana University Health la Porte Physicians Inc

  • Multi-Specialty Clinic/Center
  • La Porte, IN
National Provider Identifier
1760593776
Registry record updated May 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
INDIANA UNIVERSITY HEALTH LA PORTE PHYSICIANS INC
Practice address
1007 Lincolnway
La Porte, IN 46350-3201
Phone
(219) 326-2489
Fax
(219) 326-2584
NPI assigned
Aug 31, 2006
Last updated
May 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2014

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

Authorized official

Name
Brian Donnelly
Title
VP of Strategy & Ambulatory Service
Phone
(219) 325-4682

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1007 Lincolnway
La Porte, IN 46350-3201

Mailing address

PO Box 1690
La Porte, IN 46352-1690
Phone (219) 326-2312

Other identifiers 3

IdentifierTypeStateIssuer
200255890MedicaidIN
200988350MedicaidIN
100165070MedicaidIN

Other names 1

  • La Porte Regional Physician Network Inc Former legal business name

Medicare participation

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7002 W Johnson Rd
La Porte, IN 46350
Phone (219) 325-0604

901 Lincolnway
Ste 206
Laporte, IN 46350
Phone (219) 324-3053

30 W Buffalo St
New Buffalo, MI 49117
Phone (269) 469-1347

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2016 Change of OwnershipThis provider was the seller Knox Family Medical CenterCCN 153857, IN, NPI 1770936965

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 7

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400716800000",
    "number": "1760593776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1690",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463521690",
            "telephone_number": "219-326-2312",
            "fax_number": "219-326-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 LINCOLNWAY",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503201",
            "telephone_number": "219-326-2489",
            "fax_number": "219-326-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH LA PORTE PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-05-22",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VP OF STRATEGY & AMBULATORY SERVICE",
        "authorized_official_telephone_number": "219-325-4682"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200255890",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200988350",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100165070",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Porte Regional Physician Network Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in La Porte, IN

Sources for this page

Verify at the official NPI Registry.