NPIMap

Organization Active NPI

Open Door Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Muncie, IN
National Provider Identifier
1902851082
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR HEALTH SERVICES, INC.
Practice address
333 S Madison St
Muncie, IN 47305-2465
Phone
(765) 286-7000
Fax
(765) 213-2769
NPI assigned
May 24, 2006
Last updated
Feb 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Authorized official

Name
Mr. Bryan Ayars
Title
Chief Executive Officer
Phone
(765) 281-4257

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

333 S Madison St
Muncie, IN 47305-2465

Mailing address

PO Box 1676
Muncie, IN 47308-1676
Phone (765) 281-4257

Other identifiers 1

IdentifierTypeStateIssuer
200167970MedicaidIN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000592 IN Part B Supplier - Clinic/Group Practice 5890696603 Receives reassigned benefits from 58 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Muncie, IN; Hartford City, IN; Anderson, IN
O20100816000186 IN Part A Provider - Federally Qualified Health Center (FQHC) 5890696603 Practice locations: Muncie, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902851082. Details of each certification follow.

Federally qualified health center certification: CCN 151822

Legal name
OPEN DOOR HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 20, 2001
Last certification
May 20, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1997 in IN
Enrollment address
333 S Madison
Muncie, IN 47305-2465

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

2600 W White River Blvd
Muncie, IN 47303
Phone (765) 254-5602

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Allen Johnstone Individual Corporate OfficerBoard Member Apr 18, 2019
Susan Dillon Individual Corporate OfficerBoard Member Mar 25, 2020
Patricia Kennedy Individual Corporate OfficerBoard Member Apr 18, 2019
Jeff Huff Individual Corporate OfficerBoard Member Apr 18, 2019
Jennifer Parks-Strack Individual Corporate OfficerBoard Member Jan 20, 2021
Michelle a Altobella Individual Corporate OfficerBoard Member Apr 18, 2019
Glenn E Stone Individual Corporate DirectorBoard Chairman Apr 18, 2019
Jean Marie Place Individual Corporate OfficerBoard Member Oct 7, 2020
Kenyonta Hudson Individual Corporate OfficerBoard Member Apr 18, 2019
Bryan W Ayars Individual Corporate OfficerCeo Jun 1, 2016 100%
W-2 Managing EmployeeCeo Jun 1, 2016 100%
Kathy L Vermeulen Individual Corporate OfficerBoard Member Nov 21, 2019
Annette Craycraft Individual Corporate OfficerBoard Member Sep 18, 2019

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Open Door Pediatrics and Family MedicineMuncie, IN, CCN 151046 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2018
Open Door School-Based HealthMuncie, IN, CCN 151135 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 24, 1997
Open Door Health Services Blackford CountyHartford City, IN, CCN C51032 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 2024
Open Door Health Services YMCAMuncie, IN, CCN C51091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2025

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1902851082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1676",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473081676",
            "telephone_number": "765-281-4257",
            "fax_number": "765-213-2769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S MADISON ST",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473052465",
            "telephone_number": "765-286-7000",
            "fax_number": "765-213-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "AYARS",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "765-281-4257",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200167970",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

Verify at the official NPI Registry.