Active NPI
American Health Network of Indiana, LLC
- Family Medicine Physician
- Sheridan, IN
National Provider Identifier
1861502312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
- Practice address
- 611 E 10TH St
Sheridan, IN 46069-9106 - Phone
- (317) 758-4477
- Fax
- (317) 758-0936
- NPI assigned
- Aug 30, 2006
- Organization subpart
- Yes
- Parent organization
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ben H Park, MD
- Title
- President and Ceo
- Phone
- (317) 580-6307
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Hematology & Oncology Physician | 207RH0003X | |||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Orthopaedic Surgery Physician | 207X00000X | |||
| Physical Medicine & Rehabilitation Physician | 208100000X | |||
| Neurology Physician | 2084N0400X | |||
| Pain Medicine (Psychiatry & Neurology) Physician | 2084P2900X | |||
| Nuclear Radiology Physician | 2085N0904X | |||
| Diagnostic Radiology Physician | 2085R0202X | |||
| Diagnostic Ultrasound Physician | 2085U0001X | |||
| Surgery Physician | 208600000X | |||
| Pain Medicine Physician | 208VP0000X | |||
| Interventional Pain Medicine Physician | 208VP0014X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
611 E 10TH St
Sheridan, IN 46069-9106
Mailing address
18051 River Ave
Suite 200
Noblesville, IN 46062-7091
Phone (317) 758-4477
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0828280004 | Other | IN | DMERC |
| 200130880A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| 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
National Provider Directory- Part of
- American Health Network LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1498089600000",
"number": "1861502312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18051 RIVER AVE",
"address_2": "SUITE 200",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460627091",
"telephone_number": "317-758-4477",
"fax_number": "317-758-0936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 E 10TH ST",
"city": "SHERIDAN",
"state": "IN",
"postal_code": "460699106",
"telephone_number": "317-758-4477",
"fax_number": "317-758-0936"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMERICAN HEALTH NETWORK OF INDIANA, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AMERICAN HEALTH NETWORK OF INDIANA, LLC",
"enumeration_date": "2006-08-30",
"last_updated": "2017-06-22",
"status": "A",
"authorized_official_last_name": "PARK",
"authorized_official_first_name": "BEN",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "PRESIDENT AND CEO",
"authorized_official_telephone_number": "317-580-6307",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RH0003X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Hematology & Oncology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P2900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Pain Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Nuclear Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Ultrasound",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Pain Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0828280004",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200130880A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Sheridan, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.