NPIMap

Organization Active NPI

Meridian Health Services Corp.

Doing business as Meridian Health Services

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
National Provider Identifier
1972288736
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MERIDIAN HEALTH SERVICES CORP.
Doing business as
Meridian Health Services
Practice address
5230 E Stop 11 Rd Ste 300
Indianapolis, IN 46237-6401
Phone
(765) 288-1928
NPI assigned
Jun 20, 2023
Last updated
Jun 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Gary Gates
Title
Revenue Cycle Manager
Phone
(765) 254-2685

Specialties & licenses 1

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

Addresses

Primary practice location

5230 E Stop 11 Rd Ste 300
Indianapolis, IN 46237-6401

Mailing address

240 N Tillotson Ave
Muncie, IN 47304-3988
Phone (765) 288-1928

Other names 1

  • Meridian Health Services Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000531 IN Part B Supplier - Clinic/Group Practice 5597679845 Receives reassigned benefits from 319 practitioners
48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20231010002390 IN Part A Provider - Federally Qualified Health Center (FQHC) 5597679845 Practice locations: Indianapolis, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972288736. Details of each certification follow.

Federally qualified health center certification: CCN C51003

Legal name
MERIDIAN HEALTH SERVICES CORP
Doing business as
MERIDIAN HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 23, 2023
Last certification
Aug 23, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 3, 1971 in IN
Enrollment address
5230 E Stop 11 Rd
Ste 300
Indianapolis, IN 46237-6401

Other NPIs on the same Medicare enrollment 48

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

View all 48

National Provider Directory

National Provider Directory
Tax ID family
Meridian Health Services Corp58 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

101 W 29th St
Anderson, IN 46016
Phone (765) 356-0026

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
John Coldren Individual Corporate Director Sep 19, 2019
Steven Smith Individual Corporate Director Sep 19, 2019
Nancy Green Individual Corporate Director Sep 16, 2017
Henry a Milius Individual Corporate OfficerCeo May 20, 2002
W-2 Managing EmployeeCeo May 20, 2002
Operational/Managerial ControlCeo May 20, 2002
Wayne Shaffer Individual Corporate Director Sep 18, 2010
Christopher Fancher Individual Corporate Director Sep 14, 2013
Steven Dowling Individual Corporate Officer Apr 25, 2019
Brian Ring Individual Corporate Director Sep 17, 2011
Sue Ann Pflum Individual Corporate Director Sep 17, 2011
Meridian Health Services Corp Organization, Muncie, IN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 3, 1971 100%
Sarfraz Khan Individual Corporate OfficerCmo Dec 1, 2006
W-2 Managing EmployeeCmo Dec 1, 2006
Operational/Managerial ControlCmo Dec 1, 2006
Brent Webster Individual Corporate Director Sep 15, 2018
Scott Riggs Individual Corporate OfficerCfo Jun 1, 2015
W-2 Managing EmployeeCfo Jun 1, 2015
Operational/Managerial ControlCfo Jun 1, 2015
Scott McKee Individual Corporate Director Sep 17, 2020
Christina Bowles Individual Corporate Director Nov 20, 2014
Julie Newhouse Individual Corporate Director Feb 1, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 37

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

FacilityTypeRoleSince
Meridian Health Services CorpMuncie, IN, CCN 151883 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesRushville, IN, CCN 151919 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesRichmond, IN, CCN 151931 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesNew Castle, IN, CCN 151961 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesPortland, IN, CCN 151978 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMuncie, IN, CCN 151980 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health Services CorpConnersville, IN, CCN 151022 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 3, 1971
Meridian Health Services CorpAnderson, IN, CCN 151042 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesElwood, IN, CCN 151043 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesRichmond, IN, CCN 151075 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMuncie, IN, CCN 151076 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMuncie, IN, CCN 151078 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesIndianapolis, IN, CCN 151097 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesAnderson, IN, CCN 151104 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesPortland, IN, CCN 151105 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesWinchester, IN, CCN 151144 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesBluffton, IN, CCN 151153 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMuncie, IN, CCN 151162 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesPortland, IN, CCN 151170 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMarion, IN, CCN 151171 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesRichmond, IN, CCN 151175 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMooresville, IN, CCN C51002 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesAnderson, IN, CCN C51011 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesKokomo, IN, CCN C51018 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesLafayette, IN, CCN C51060 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesRussiaville, IN, CCN C51061 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMarkle, IN, CCN C51059 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesUnion City, IN, CCN C51063 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesOssian, IN, CCN C51065 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesPortland, IN, CCN C51068 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesPeru, IN, CCN C51069 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesBluffton, IN, CCN C51072 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesBluffton, IN, CCN C51080 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesFrankfort, IN, CCN C51084 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesWarren, IN, CCN C51086 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesFort Wayne, IN, CCN C51092 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971
Meridian Health ServicesMontpelier, IN, CCN C51113 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 3, 1971

Facilities with the same owner 37

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 37

Practitioners & affiliated clinicians

Practitioners 6

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": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1972288736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N TILLOTSON AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473043988",
            "telephone_number": "765-288-1928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 E STOP 11 RD STE 300",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462376401",
            "telephone_number": "765-288-1928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN HEALTH SERVICES CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "765-254-2685"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.