Providence Medical Group LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PROVIDENCE MEDICAL GROUP LLC

Practice address

2723 S 7TH St
Suite a
Terre Haute, IN 47802-3558

Phone

(812) 232-8164

Fax

(812) 234-6391

NPI assigned

Jul 11, 2006

Last updated

Sep 29, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

George B BittarNPI 1801869615

Title

Owner

Phone

(812) 232-8164

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IN, IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Union Hospital Inc

  dba Brazil Family Medicine

  • Rural Health Clinic/Center
  • Brazil, IN
  • NPI 1013087048

  Member Of

  NPD member

Locations

Practitioners 59

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.

• George B Bittar, MD

  • Cardiovascular Disease Physician
  • Terre Haute, IN
  • NPI 1801869615
  Medicare reassignment Care Compare group NPD Authorized official
• Mohammad S Alam, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Terre Haute, IN
  • NPI 1972577591
  Medicare reassignment Care Compare group NPD
• Elias A Dalloul, MD

  • Cardiovascular Disease Physician
  • Terre Haute, IN
  • NPI 1316910912
  Medicare reassignment Care Compare group NPD
• Henry J Davis, MD

  • Rheumatology Physician
  • Terre Haute, IN
  • NPI 1174597538
  Medicare reassignment Care Compare group NPD
• Whitney Marie Harvey, FNP

  • Family Nurse Practitioner
  • Terre Haute, IN
  • NPI 1083433023

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Neil G Kabous, MD

  • Cardiovascular Disease Physician
  • Terre Haute, IN
  • NPI 1174597744
  Medicare reassignment Care Compare group NPD
• Nawar F Mercho, MD

  • Cardiovascular Disease Physician
  • Terre Haute, IN
  • NPI 1124092325
  Medicare reassignment Care Compare group NPD
• Lee Ann Murray, FNP

  • Family Nurse Practitioner
  • Terre Haute, IN
  • NPI 1265286215
  Medicare reassignment Care Compare group NPD
• Tony K. Nasser, MD

  • Cardiovascular Disease Physician
  • Terre Haute, IN
  • NPI 1104803295

  IL

  Medicare reassignment Care Compare group NPD
• Thomas F Orman, MD

  • Cardiovascular Disease Physician
  • Terre Haute, IN
  • NPI 1386618536
  Medicare reassignment Care Compare group NPD
• Staci Rice, CNP

  • Nurse Practitioner
  • Terre Haute, IN
  • NPI 1942711643
  Medicare reassignment Care Compare group NPD
• Ashley Nicole Richey, FNP- BC

  • Family Nurse Practitioner
  • Terre Haute, IN
  • NPI 1609539923
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790640000000",
    "number": "1891729141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2723 S 7TH ST STE A",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478023558",
            "telephone_number": "812-238-1730",
            "fax_number": "818-242-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2723 S 7TH ST",
            "address_2": "SUITE A",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478023558",
            "telephone_number": "812-232-8164",
            "fax_number": "812-234-6391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A",
        "authorized_official_last_name": "BITTAR",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-232-8164"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200261130",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG4466",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH9272",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200398780",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Proctor, NP
• Nathan Propst, PHARMD
• Providence Cardiovascular Lab, LLC
• Providence Medical Group LLC
• Psychological & Educational Resources, Inc
• Vincent Puccia, M.D.
• Puchalapalli M D, Inc.
• Subbareddy Puchalapalli, M.D.

• Multi-Specialty Clinic/Center in Terre Haute, IN
• Providers in Terre Haute, IN by specialty
• Multi-Specialty Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.