NPIMap

Organization Active NPI

Indiana Health Centers, Inc

Doing business as South Bend at Oaklawn

  • Federally Qualified Health Center (FQHC)
  • South Bend, IN
National Provider Identifier
1912327693
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INDIANA HEALTH CENTERS, INC
Doing business as
South Bend at Oaklawn
Practice address
415 E Madison St
South Bend, IN 46617-2322
Phone
(574) 234-9033
Fax
(574) 234-9059
NPI assigned
Apr 22, 2014
Last updated
Mar 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
INDIANA HEALTH CENTERS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Authorized official

Name
Mr. Tracy J Nagel
Title
Cfo
Phone
(317) 576-1335

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

415 E Madison St
South Bend, IN 46617-2322

Mailing address

8003 Castleway Dr
Indianapolis, IN 46250-1946
Phone (317) 576-1335

Other identifiers 1

IdentifierTypeStateIssuer
100071250MedicaidIN

Other names 1

  • SOUTH BEND AT OAKLAWN Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140703001021 IN Part A Provider - Federally Qualified Health Center (FQHC) 3971599473 Practice locations: South Bend, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912327693. Details of each certification follow.

Federally qualified health center certification: CCN 151926

Legal name
INDIANA HEALTH CENTERS INC
Doing business as
INDIANA HEALTH CENTERS SOUTH BEND AT OAKLAWN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 28, 2014
Last certification
Jul 28, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
415 E Madison St
South Bend, IN 46617-2322

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Indiana Health Centers Inc22 organizations share this tax ID, including this one
Part of
Indiana Health Centers Inc

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

8003 Castleway Dr
Indianapolis, IN 46250
Phone (317) 576-1335

116 E 32nd St
Ste A
Marion, IN 46953
Phone (765) 664-7492

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Rebekah Price Individual Corporate DirectorBoard Member Feb 29, 2020
Brian P Kelly Individual Corporate DirectorBoard Member Sep 26, 2015
Earl H Lane Individual Corporate DirectorBoard Member Apr 10, 2011
Ann Lundy Individual Corporate OfficerCeo Jun 1, 2022
Michael D Busch Individual Corporate DirectorBoard Member Sep 24, 1996
Nicole Meyer Individual Corporate OfficerCoo Jan 30, 2025
Tracy J Nagel Individual Corporate OfficerChief Financial Officer Jun 2, 2008
W-2 Managing Employee Jun 2, 2008
Tamara L Habegger Individual Corporate DirectorBoard Member Mar 28, 2015
David McDonald Individual Corporate DirectorBoard Member Sep 24, 2016
Ayotade Ojutalayo Individual Corporate DirectorBoard Member Oct 1, 2012
Maricela Navarro Individual Corporate DirectorBoard Member Aug 24, 2019
Andrea R Graham Individual Corporate DirectorBoard Member Jun 27, 2015
Bernard J Emkes Individual Corporate DirectorBoard Member Jun 6, 2003

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1912327693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "317-576-1335",
            "fax_number": "317-576-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E MADISON ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172322",
            "telephone_number": "574-234-9033",
            "fax_number": "574-234-9059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA HEALTH CENTERS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIANA HEALTH CENTERS, INC",
        "enumeration_date": "2014-04-22",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "NAGEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-576-1335",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071250",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH BEND AT OAKLAWN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTH BEND AT OAKLAWN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.