American Health Network of Indiana, LLC
Organization Active NPI Family Medicine Physician · Lafayette, IN
NPI 1780610089 · NPPES record last updated Jan 22, 2009
Key facts
- NPI
- 1780610089
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
- Practice address
- 3750 Landmark Drive
Suite a
Lafayette, IN 47905 - Phone
- (765) 448-4511
- Fax
- (765) 447-8375
- NPI assigned
- Jun 25, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
Authorized official
- Name
- Ben H Park, M.D.
- Title
- President and Ceo
- Phone
- (317) 580-6307
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031124000691 | IN | Part B Supplier - Clinic/Group Practice | 9830093533 |
Receives reassigned benefits from 230 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- American Health Network LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Hematology & Oncology Physician |
207RH0003X | |||
| Neurology Physician |
2084N0400X | |||
| Diagnostic Radiology Physician |
2085R0202X | |||
| Diagnostic Ultrasound Physician |
2085U0001X | |||
| Foot & Ankle Surgery Podiatrist |
213ES0103X |
Addresses
Primary practice location
3750 Landmark Drive
Suite a
Lafayette, IN 47905
Mailing address
3750 Landmark Drive
Suite a
Lafayette, IN 47905
Phone (765) 448-4511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0828280023 | Other | IN | DMERC |
| 153833 | Other | IN | MEDICARE RURAL HEALTH |
| 200127640A | Medicaid | IN |
Other providers in Lafayette, IN
- Safiro Alvarado
- Sandy Amador
- Stephanie Celia Ambre
- Amedisys SP-in, L.L.C
- American Health Network of Indiana, LLC
- American Orthopedic & Prosthetics Inc.
- American Oxygen &Medical Equipment, Inc.
- Americare Ambulance Service of Lafayette, LLC
- Americare Medical Transport LLC
- Christopher Jon Amptmeyer
All providers in Lafayette, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2009. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.