Proactive Mso, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROACTIVE MSO, LLC

Practice address

3495 S 4TH St
Terre Haute, IN 47802-5501

Phone

(812) 220-4755

NPI assigned

Jan 12, 2018

Organization subpart

No

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Lynne Mata, PA-C

  • Medical Physician Assistant
  • Terre Haute, IN
  • NPI 1518912971
  NPD
• Megan Elizabeth Marietta, FNP-C

  • Family Nurse Practitioner
  • Terre Haute, IN
  • NPI 1992211965
  NPD (past)

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

CLIA laboratory certificates

Tax ID family

W Lafayette Health Center35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Spencer, IN
  • NPI 1033662820
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Winamac, IN
  • NPI 1063058311
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Veedersburg, IN
  • NPI 1073066056
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Merrillville, IN
  • NPI 1073066866
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Plymouth, IN
  • NPI 1083250351
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Brazil, IN
  • NPI 1174076145
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Crawfordsville, IN
  • NPI 1174169908
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • New Carlisle, IN
  • NPI 1275179541
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Bloomington, IN
  • NPI 1275371080
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Union Mills, IN
  • NPI 1285359679
  NPD tax ID
• Proactive Mso, LLC

  • Clinic/Center
  • Martinsville, IN
  • NPI 1316811433
  NPD tax ID
• Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Vincennes, IN
  • NPI 1326577396
  NPD tax ID

Locations

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

Authorized official

Name

Jan Hopkins

Title

Assoc. Ops MGR

Phone

(864) 501-0751

Specialties & licenses 1

Addresses

Other names 2

• Proactive MD Terre Haute Health Center Doing business as
• Proactive MD Other name

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1972011815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3495 S 4TH ST",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478025501",
            "telephone_number": "812-220-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MSO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "ASSOC. OPS MGR",
        "authorized_official_telephone_number": "864-501-0751"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD Terre Haute Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proactive MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Josh Price
• Stephen L Price, D.C.
• Megan Lynn Priddy, ATC
• Kadesha Prifogle
• Proactive Mso, LLC
• Procare Medical LLC
• Rebecca Proctor, NP
• Nathan Propst, PHARMD
• Providence Cardiovascular Lab, LLC
• Providence Cath Lab

• All providers in Terre Haute, IN
• Primary Care Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.