NPIMap

Organization Active NPI

Glendale Advanced Health, LLC

  • General Practice Physician
  • Indianapolis, IN
National Provider Identifier
1992311104
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GLENDALE ADVANCED HEALTH, LLC
Practice address
6321 N. Keystone Ave
Ste. B
Indianapolis, IN 46220
Phone
(317) 257-2225
NPI assigned
Sep 22, 2020
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Joseph FortunatoNPI 1639157407
Title
Owner
Phone
(317) 257-2225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

6321 N. Keystone Ave
Ste. B
Indianapolis, IN 46220

Mailing address

6321 N Keystone Ave
Suite B
Indianapolis, IN 46220-2156
Phone (317) 257-2225

National Provider Directory

National Provider Directory

Locations

6321 N Keystone Ave
#B
Indianapolis, IN 46220
Phone (317) 257-2225

Practitioners & affiliated clinicians

Practitioners 12

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": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1992311104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6321 N KEYSTONE AVE",
            "address_2": "SUITE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462202156",
            "telephone_number": "317-257-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6321 N. KEYSTONE AVE",
            "address_2": "STE. B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46220",
            "telephone_number": "317-257-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE ADVANCED HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "FORTUNATO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-257-2225"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.