Indiana Health Centers, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · South Bend, IN
NPI 1780065672 · NPPES record last updated Mar 17, 2023
Key facts
- NPI
- 1780065672
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- INDIANA HEALTH CENTERS, INC
- Practice address
- 1010 N Bendix Dr
South Bend, IN 46628-1925 - Phone
- (574) 245-4984
- Fax
- (574) 245-4981
- NPI assigned
- Jun 16, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Tracy J Nagel
- Title
- Cfo
- Phone
- (317) 576-1335
Owners & managing parties with NPI records 1
-
Addison G Haynes, DO
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 21
Practitioners 63
-
Amber Gonzales, LCSW
-
Akila T Karanja, FNP-BC
-
Bethany Ann Wait, DO
-
Soneka Wynter, NP
-
Lisa Achenbach, NP
-
Alexander Allison, LCSW
-
John R. Anderson, MA
-
Leigh Anderson, FNP-C
-
Mackenzie Elise Binkley, LCSW
-
Megan L Catt, FNP-C
-
Elizabeth Dulmes, N.P.
-
Jodi Durst, FNP
-
Kristina K Glick, RN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Federally qualified health center certification: CCN 151955
- Legal name
- INDIANA HEALTH CENTERS INC
- Doing business as
- IHC BENDIX COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 24, 2015
- Last certification
- Aug 24, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1010 N Bendix Dr
South Bend, IN 46628-1925
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Rebekah Price |
Corporate Director |
Feb 29, 2020 | |
| Brian P Kelly |
Corporate Director |
Sep 26, 2015 | |
| Earl H Lane |
Corporate Director |
Apr 10, 2011 | |
| Ann Lundy |
Corporate Officer |
Jun 1, 2022 | |
| Michael D Busch |
Corporate Director |
Sep 24, 1966 | |
| Addison G Haynes |
Corporate Officer |
Feb 4, 2026 | |
| W-2 Managing Employee |
Feb 4, 2026 | ||
| Nicole Meyer |
Corporate Director |
Aug 1, 2020 | |
| Tracy J Nagel |
Corporate Officer |
Jun 2, 2008 | |
| W-2 Managing Employee |
May 31, 2022 | ||
| Tamara L Habegger |
Corporate Director |
Mar 28, 2015 | |
| David McDonald |
Corporate Director |
Sep 24, 2016 | |
| Ayotade Ojutalayo |
Corporate Director |
Oct 1, 2012 | |
| Maricela Navarro |
Corporate Director |
Aug 24, 2019 | |
| Andrea R Graham |
Corporate Director |
Jun 27, 2015 | |
| Bernard J Emkes |
Corporate Director |
Jun 4, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150820011429 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 3971599473 | Practice locations: South Bend, IN |
National Provider Directory
- Tax ID family
- Indiana Health Centers
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1010 N Bendix Dr
South Bend, IN 46628-1925
Mailing address
8003 Castleway Dr
Indianapolis, IN 46250-1946
Phone (317) 576-1335
Other names
- IHC at Bendix Community Health Center
Other providers in South Bend, IN
- Imp Operations
- Impact Community Economic Development Corp
- Indiana Health and Rehabilitation Centers
- Indiana Health Centers, Inc
- Indiana Health Centers, Inc
- Indiana Health Centers, Inc
- Indiana Health Centers, Inc.
- Indiana Health Centers, Inc.
- Indiana Hearing LLC
- Indiana University South Bend Health & Wellness Center
All providers in South Bend, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.