NPIMap

Organization Active NPI

FC Indiana, LLC

  • Rural Health Clinic/Center
  • Bedford, IN
National Provider Identifier
1841911591
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FC INDIANA, LLC
Practice address
2418 16TH St
Bedford, IN 47421-3049
Phone
(931) 253-1110
Fax
(931) 722-9919
NPI assigned
Sep 9, 2022
Last updated
Sep 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Authorized official

Name
Sydni Clemmons
Title
Credentialing Manager
Phone
(901) 351-1791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2418 16TH St
Bedford, IN 47421-3049

Mailing address

PO Box 306414
Nashville, TN 37230-6414
Phone (931) 253-1110

Other practice location 1

315 S Memorial Dr
New Castle, IN 47362-4904
Phone (931) 253-1110

Other practice location 2

3600 E Main St
Richmond, IN 47374-5935
Phone (931) 253-1110

Other practice location 3

1202 E Tipton St
Seymour, IN 47274-3540
Phone (931) 253-1110

Medicare participation

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

National Provider Directory

National Provider Directory
Tax ID family
Brock Medical LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3600 E Main St
Richmond, IN 47374
Phone (765) 598-5700

Ownership & related parties

Change-of-ownership history 4

DateEventCounterparty
Mar 31, 2025 Change of OwnershipThis provider was the seller Fast Pace Medical Clinic PLLCCCN 153929, IN, NPI 1982362299
Mar 31, 2025 Change of OwnershipThis provider was the seller Fast Pace HealthCCN 153925, IN, NPI 1982362299
Mar 31, 2025 Change of OwnershipThis provider was the seller Fast Pace HealthCCN 153926, IN, NPI 1982362299
Mar 31, 2025 Change of OwnershipThis provider was the seller Fast Pace HealthCCN 153927, IN, NPI 1982362299

Change of ownership 1

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

Practitioners & affiliated clinicians

Practitioners 166

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.

View all 166

NPI Registry JSON

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

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662681600000",
    "number": "1841911591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306414",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306414",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 16TH ST",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474213049",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 S Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "New Castle",
            "state": "IN",
            "postal_code": "473624904",
            "country_code": "US",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 E Main St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "IN",
            "postal_code": "473745935",
            "country_code": "US",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1202 E Tipton St",
            "address_purpose": "LOCATION",
            "city": "Seymour",
            "state": "IN",
            "postal_code": "472743540",
            "country_code": "US",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FC INDIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SYDNI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "901-351-1791"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, IN

Sources for this page

Verify at the official NPI Registry.