Elevate Care Clinic LLC
Organization Active NPI Primary Care Clinic/Center · Brazil, IN
NPI 1891497590 · NPPES record last updated Mar 20, 2023
Key facts
- NPI
- 1891497590
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- ELEVATE CARE CLINIC LLC
- Practice address
- 503 W National Ave
Brazil, IN 47834-2502 - Phone
- (812) 251-4873
- NPI assigned
- Mar 20, 2023
- Organization subpart
- No
Authorized official
- Name
- Kaitlyn Nevill, FNP-C
- Title
- Owner
- Phone
- (812) 251-4873
Practitioners 2
-
Kaitlyn Nevill, FNP-C
-
Jennifer Jayne Gabriel, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2279560 | Elevate Care Clinic | Certificate of waiver | Apr 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230802002135 | IN | Part B Supplier - Clinic/Group Practice | 5597126839 |
Receives reassigned benefits from 2 practitioners Practice locations: Brazil, IN |
National Provider Directory
Locations
503 W National Ave
Brazil, IN 47834
Phone (812) 251-4873
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
503 W National Ave
Brazil, IN 47834-2502
Mailing address
4160 N Private Road 220 E
Brazil, IN 47834-8354
Phone (812) 251-4873
Other providers in Brazil, IN
- Robert S Donathan
- Dr Linda Colter LLC
- Drummer Dialysis LLC
- Rhonda Earl
- Elder'S Journey Home Care of Wabash Valley Inc.
- Anthony M Elmes
- Empowerme Medical Group, PC
- Austin England
- Michele L Engle
- Eyecare Specialists
All providers in Brazil, IN · Primary Care Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.