NPIMap

Organization Active NPI

Raphael Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
National Provider Identifier
1881383420
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RAPHAEL HEALTH CENTER, INC
Practice address
711 E Washington St
Indianapolis, IN 46202-3915
Phone
(317) 226-4248
NPI assigned
May 1, 2023
Last updated
Jul 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Paul M Utterback
Title
Cfo
Phone
(317) 226-4248

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU
Medical Specialty Clinic/Center 261QM2500X NU

Addresses

Primary practice location

711 E Washington St
Indianapolis, IN 46202-3915

Mailing address

401 E 34TH St
Indianapolis, IN 46205-3754
Phone (317) 226-4248

Other names 1

  • Raphael Health Center - Salvation Army Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041227000466 IN Part B Supplier - Clinic/Group Practice 4486562659 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indianapolis, IN
O20230824003338 IN Part A Provider - Federally Qualified Health Center (FQHC) 4486562659 Practice locations: Indianapolis, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881383420. Details of each certification follow.

Federally qualified health center certification: CCN 151197

Legal name
RAPHAEL HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 19, 2023
Last certification
Jul 19, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Oct 18, 1994 in IN
Enrollment address
711 E Washington St
Indianapolis, IN 46202-3915

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Raphael Health Center2 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

711 E Washington St
Indianapolis, IN 46202
Phone (317) 226-4248

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Paul Utterback Individual Corporate OfficerCfo May 3, 2023
W-2 Managing EmployeeCfo May 3, 2023
Operational/Managerial ControlCfo May 3, 2023
Sherry Gray Individual Corporate OfficerCeo May 3, 2023
W-2 Managing EmployeeCeo May 3, 2023
Operational/Managerial ControlCeo May 3, 2023
Raphael Health Center Inc Organization, Indianapolis, IN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 18, 1994 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1881383420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E 34TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462053754",
            "telephone_number": "317-226-4248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 E WASHINGTON ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023915",
            "telephone_number": "317-226-4248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAPHAEL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "UTTERBACK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-226-4248"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raphael Health Center - Salvation Army",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.