American Health Network of Indiana, LLC
Organization Active NPI Family Medicine Physician · Avon, IN
NPI 1902850837 · NPPES record last updated Feb 15, 2011
Key facts
- NPI
- 1902850837
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
- Practice address
- 5250 E US Highway 36
Suite 610
Avon, IN 46123-7877 - Phone
- (317) 745-5403
- Fax
- (317) 718-2180
- NPI assigned
- May 22, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- AMERICAN HEALTH NETWORK OF INDIANA, LLC
Authorized official
- Name
- Ben H Park I, MD
- Title
- President and Ceo
- Phone
- (317) 580-6309
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| 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
- Part of
- American Health Network LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Neurology Physician |
2084N0400X | |||
| Nuclear Radiology Physician |
2085N0904X | |||
| Diagnostic Radiology Physician |
2085R0202X |
Addresses
Primary practice location
5250 E US Highway 36
Suite 610
Avon, IN 46123-7877
Mailing address
5250 East US Highway 36
Suite 610
Avon, IN 46123-7877
Phone (317) 745-5403
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100133190A | Medicaid | IN |
Other providers in Avon, IN
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- American Health Network of Indiana, LLC
- Amy Levy Mental Health Services NP LLC
- Anchor Pointe
- Martin Julius Andersen
- Anderson Chiropractic PC Inc
- Chelsea Nicole Anderson
All providers in Avon, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2011. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.