Active NPI
Excell for Life Family Care and Pediatrics Inc.
- Family Medicine Physician
- Indianapolis, IN
National Provider Identifier
1902192016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01036098A
- Legal business name
- EXCELL FOR LIFE FAMILY CARE AND PEDIATRICS INC.
- Practice address
- 1329 W 96TH St
Suite 1
Indianapolis, IN 46260-1190 - Phone
- (317) 660-0888
- Fax
- (317) 660-0880
- NPI assigned
- Jun 27, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa A Miller, MD
- Title
- Owner
- Phone
- (317) 660-0888
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01036098A | IN | Primary |
Addresses
Primary practice location
1329 W 96TH St
Suite 1
Indianapolis, IN 46260-1190
Mailing address
1329 W 96TH St
Suite 1
Indianapolis, IN 46260-1190
Phone (317) 660-0888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110906000009 | IN | Part B Supplier - Clinic/Group Practice | 5395915169 |
Receives reassigned benefits from 11 practitioners Practice locations: Indianapolis, IN |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2029907 | Excell for Life Family Care & Pediatrics | Provider-performed microscopy | Sep 15, 2027 |
National Provider Directory
National Provider DirectoryLocations
1329 W 96th St
Ste 1
Indianapolis, IN 46260
Phone (317) 660-0888
Interoperability endpoints
- https://api.platform.athenahealth.com/23703/brand/1/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309132800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1477440000000",
"number": "1902192016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1329 W 96TH ST",
"address_2": "SUITE 1",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601190",
"telephone_number": "317-660-0888",
"fax_number": "317-660-0880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1329 W 96TH ST",
"address_2": "SUITE 1",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601190",
"telephone_number": "317-660-0888",
"fax_number": "317-660-0880"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EXCELL FOR LIFE FAMILY CARE AND PEDIATRICS INC.",
"organizational_subpart": "NO",
"enumeration_date": "2011-06-27",
"last_updated": "2016-10-26",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "317-660-0888",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "IN",
"license": "01036098A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; 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.