NPIMap

Organization Active NPI

Aspire Indiana Health Inc.

Doing business as Aspire Indiana Health - Madison-Grant

  • Federally Qualified Health Center (FQHC)
  • Fairmount, IN
National Provider Identifier
1821765884
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ASPIRE INDIANA HEALTH INC.
Doing business as
Aspire Indiana Health - Madison-Grant
Practice address
11640 S E 00 W
Fairmount, IN 46928-9318
Phone
(317) 574-1254
Fax
(317) 674-0060
NPI assigned
Aug 26, 2021
Last updated
Nov 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Authorized official

Name
Timothy D Crockett
Title
Chief Financial Officer
Phone
(317) 587-0505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

11640 S E 00 W
Fairmount, IN 46928-9318

Mailing address

9615 E 148TH St Ste 1
Noblesville, IN 46060-4371
Phone (317) 574-1254

Other names 1

  • Aspire Indiana Health - Madison-Grant Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150902001749 IN Part B Supplier - Clinic/Group Practice 8921314196 Receives reassigned benefits from 203 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anderson, IN; Noblesville, IN; Lebanon, IN; Indianapolis, IN; Carmel, IN; Elwood, IN
O20210831000284 IN Part A Provider - Federally Qualified Health Center (FQHC) 8921314196 Practice locations: Fairmount, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821765884. Details of each certification follow.

Federally qualified health center certification: CCN 151118

Legal name
ASPIRE INDIANA HEALTH INC
Doing business as
ASPIRE INDIANA HEALTH - MADISON-GRANT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 30, 2021
Last certification
Aug 30, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 25, 2015 in IN
Enrollment address
11640 S E 00 W
Fairmount, IN 46928-9318

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

11640 S E 00 W
Fairmount, IN 46928

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Amy Matthews Individual Corporate DirectorBoard Member Aug 1, 2012
Carolyn Barr Individual Corporate DirectorBoard Member Aug 1, 2015
Karl Stout Individual Corporate DirectorBoard Member Aug 12, 2019
Michael Collette Individual Corporate DirectorBoard Member Aug 1, 2018
Shelagh Anne Fraser Individual Corporate DirectorBoard Member Aug 1, 2015
Timothy Crockett Individual Corporate OfficerChief Financial Officer Aug 1, 2018
W-2 Managing EmployeeChief Financial Officer Aug 1, 2018
Operational/Managerial ControlChief Financial Officer Aug 1, 2018
Joseph E Vosburgh Individual Corporate DirectorBoard Member Jul 1, 2015
John Demaree Individual Corporate DirectorBoard Member Aug 1, 2010
Trent Scott Individual Corporate DirectorBoard Member Aug 1, 2014
Jody Horstman Individual Corporate OfficerChief Integration Officer Dec 13, 2018
Corporate DirectorChief Integration Officer Dec 13, 2018
Majorie Shell Individual Corporate DirectorBoard Member Jul 1, 2015
Leroy Quashie Individual Corporate DirectorBoard Member Jul 1, 2010
Ted Sherfick Individual Corporate DirectorBoard Member Aug 1, 2019
Michael Hall Individual Corporate DirectorBoard Member Aug 12, 2019
James Skeel Individual Corporate OfficerChief Quality Officer Aug 12, 2019
Corporate DirectorChief Quality Officer Aug 12, 2019
Jeffrey L Reed Individual Corporate Director Aug 1, 2000
Duane Hoak Individual Corporate DirectorBoard Member Jul 1, 2010
Obadiah Smith Individual Corporate DirectorBoard Member Aug 1, 2015
Eric a Marcotte Individual Corporate DirectorBoard Member Aug 1, 2019
Rob Spaulding Individual Corporate DirectorBoard Member Aug 1, 2017
David Speicher Individual Corporate OfficerChief Technology Officer Dec 13, 2018
Corporate DirectorChief Technology Officer Dec 13, 2018
Barbara Scott Individual Corporate OfficerPresident/Ceo Jul 1, 2015
W-2 Managing EmployeePresident/Ceo Jul 1, 2015
Operational/Managerial ControlPresident/Ceo Jul 1, 2015
John H Plumb Individual Corporate DirectorBoard Member Aug 12, 2019
Daniel Stevens Individual Corporate DirectorBoard Member Aug 1, 2017

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anderson Indiana Health - WillowbrookIndianapolis, IN, CCN 151004 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2015
Aspire Indiana Health IncElwood, IN, CCN 151003 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2015
Aspire May HouseAnderson, IN, CCN 151002 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2015
Aspire Indiana Health IncAnderson, IN, CCN 151001 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2015
Aspire Indiana Health - CarmelCarmel, IN, CCN 151008 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2015
Aspire Indiana Health - Boone CountyLebanon, IN, CCN 151014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 31, 2018
Aspire Indiana Health-NoblesvilleNoblesville, IN, CCN 151017 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2015
Aspire Indiana Health - Progress House MainIndianapolis, IN, CCN 151084 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 25, 2015

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1821765884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9615 E 148TH ST STE 1",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460604371",
            "telephone_number": "317-574-1254",
            "fax_number": "317-674-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11640 S E 00 W",
            "city": "FAIRMOUNT",
            "state": "IN",
            "postal_code": "469289318",
            "telephone_number": "317-574-1254",
            "fax_number": "317-674-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASPIRE INDIANA HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-26",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "317-587-0505"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspire Indiana Health - Madison-Grant",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmount, IN

Sources for this page

Verify at the official NPI Registry.