Active NPI
Shalom Health Care Center, Inc.
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- SHALOM HEALTH CARE CENTER, INC.
- Practice address
- 3400 Lafayette Road
Suite 200
Indianapolis, IN 46222-1147 - Phone
- (317) 291-7422
- Fax
- (317) 291-7433
- NPI assigned
- Apr 24, 2007
- Last updated
- Mar 30, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Leonardo R Ortega, M.D., M.P.H.
- Title
- Executive Director
- Phone
- (317) 291-7422
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary | ||
| Physician Assistant | 363A00000X | |||
| Medical Physician Assistant | 363AM0700X | |||
| Family Nurse Practitioner | 363LF0000X | |||
| Pediatric Nurse Practitioner | 363LP0200X | |||
| Family Medicine Physician | 207Q00000X | |||
| Internal Medicine Physician | 207R00000X | |||
| Pediatrics Physician | 208000000X | |||
| Psychiatry Physician | 2084P0800X |
Addresses
Primary practice location
3400 Lafayette Road
Suite 200
Indianapolis, IN 46222-1147
Mailing address
3400 Lafayette Road
Suite 200
Indianapolis, IN 46222-1147
Phone (317) 291-7422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200392480 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 12
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040310000486 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20040310000775 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20040621000467 | IN | Part B Supplier - Clinic/Group Practice | 3779471750 |
Receives reassigned benefits from 27 practitioners 4 other NPIs on this enrollment Practice locations: Indianapolis, IN; Speedway, IN |
| O20050706000280 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20150330000363 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20150423002045 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20150506000068 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20230418001335 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20240829003576 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20250415000849 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20250616002560 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
| O20260421001326 | IN | Part A Provider - Federally Qualified Health Center (FQHC) | 3779471750 | Practice locations: Indianapolis, IN |
NPI to CCN mapping 11
The Medicare certification numbers (CCNs) connected to NPI 1992924633. Details of each certification follow.
- CCN 151830
- CCN 151831
- CCN 151839
- CCN 151939
- CCN 151942
- CCN 151943
- CCN 151188
- CCN C51050
- CCN C51087
- CCN C51093
- CCN C51120
Federally qualified health center certification: CCN 151830
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 22, 2004
- Last certification
- Apr 22, 2004
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 4326 Patricia St
Indianapolis, IN 46222-1543
Federally qualified health center certification: CCN 151831
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 22, 2004
- Last certification
- Apr 22, 2004
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 3725 Kiel Ave
Room 105
Indianapolis, IN 46224-1228
Federally qualified health center certification: CCN 151839
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 13, 2005
- Last certification
- Jul 13, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 3400 Lafayette Rd
Ste 200
Indianapolis, IN 46222-1147
Federally qualified health center certification: CCN 151939
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Doing business as
- STEPHEN FOSTER ELEMENTARY SCHOOL BASED CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 26, 2015
- Last certification
- Mar 26, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 653 N Somerset Ave
Indianapolis, IN 46222-3327
Federally qualified health center certification: CCN 151942
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Doing business as
- INDIANA MATH AND SCIENCE ACADEMY NORTH SCHOOL BASED CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 7, 2015
- Last certification
- May 7, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 7435 N Keystone Ave
Indianapolis, IN 46240-4367
Federally qualified health center certification: CCN 151943
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Doing business as
- INDIANA MATH AND SCIENCE ACADEMY WEST
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 18, 2015
- Last certification
- Apr 18, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 4575 W 38TH St
Indianapolis, IN 46254-3313
Federally qualified health center certification: CCN 151188
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Doing business as
- IPS SCHOOL 46 - DANIEL WEBSTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 30, 2023
- Last certification
- Mar 30, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 1450 S Reisner St
Ste 100
Indianapolis, IN 46221-1637
Federally qualified health center certification: CCN C51050
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 9, 2024
- Last certification
- Aug 9, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Aug 27, 2002 in IN
- Enrollment address
- 3401 N Meridian St
Indianapolis, IN 46208-4436
Federally qualified health center certification: CCN C51087
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 10, 2025
- Last certification
- Apr 10, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Enrollment address
- 1501 E 10TH St
Indianapolis, IN 46201-1909
Federally qualified health center certification: CCN C51093
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 9, 2025
- Last certification
- Jun 9, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Enrollment address
- 2215 W Washington St
Indianapolis, IN 46222-4279
Federally qualified health center certification: CCN C51120
- Legal name
- SHALOM HEALTH CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 2, 2026
- Last certification
- Apr 2, 2026
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Enrollment address
- 5525 W 34TH St
RM 180
Indianapolis, IN 46224-1301
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Shalom 56th Street-New Access Point
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1003275512
3779471750
-
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1770267486
3779471750
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Shalom 56th Street-New Access Point
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1003275512
O20040621000467
-
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1538167036
O20040621000467
-
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1770267486
O20040621000467
-
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1982242327
O20040621000467
National Provider Directory
National Provider DirectoryLocations
1163 N Belmont Ave
#63
Indianapolis, IN 46222
1250 E Market St
Indianapolis, IN 46202
Phone (317) 226-4214
1404 Wade St
Eleanor Skillen 34
Indianapolis, IN 46203
1450 S Reisner St
Ste 100
Indianapolis, IN 46221
Phone (317) 291-7433
1734 Fletcher Ave
Rm 404
Indianapolis, IN 46203
Phone (317) 226-4239
2033 Sugar Grove Ave
Rm 140
Indianapolis, IN 46202
Phone (317) 226-4244
3307 Ashway Dr
#107
Indianapolis, IN 46224
Phone (317) 226-4107
3426 Roosevelt Ave
#51
Indianapolis, IN 46218
3725 N Kiel Ave
Indianapolis, IN 46224
Phone (317) 226-4194
4326 Patricia St
#61
Indianapolis, IN 46222
4825 N Arlington Ave
Indianapolis, IN 46226
Phone (317) 226-2345
4950 W 34th St
Indianapolis, IN 46224
Phone 3172979100111
5002 W 34th St
#79
Indianapolis, IN 46224
545 E 19th St
Rm 145
Indianapolis, IN 46202
Phone (317) 226-4227
5525 W 34th St
Rm 179
Indianapolis, IN 46224
Phone (317) 693-5657
5750 W 56th St
Indianapolis, IN 46254
Phone (317) 291-1411
5801 E 30th St
#99
Indianapolis, IN 46218
Phone (317) 226-4299
653 N Somerset Ave
Indianapolis, IN 46222
Phone (317) 226-4267
653 N Somerset Ave
#67
Indianapolis, IN 46222
8620 Montery Rd
#105
Indianapolis, IN 46226
9240 N Meridian St
Ste 180
Indianapolis, IN 46260
Phone (317) 582-1100
5700 Meadowood Dr
Speedway, IN 46224
Phone (317) 291-4274
Ownership & related parties
All disclosed owners & managing parties 21
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Teresa Driskell | Corporate Officer | Sep 1, 2015 | |
| W-2 Managing Employee | Sep 1, 2015 | ||
| W-2 Managing Employee | Jan 1, 2022 | ||
| Leonardo R Ortega | Corporate Officer | Jul 2, 2012 | |
| Corporate Officer | Jul 2, 2012 | ||
| Corporate Officer | Jul 1, 2012 | ||
| W-2 Managing Employee | Jul 1, 2012 | ||
| Corporate Officer | Jul 2, 2012 | ||
| W-2 Managing Employee | Jul 2, 2012 | ||
| Corporate Director | Jul 1, 2012 | ||
| Corporate Director | Jul 1, 2012 | ||
| W-2 Managing Employee | Jul 1, 2012 | ||
| Douglas Frye | Corporate Director | Apr 1, 2023 | |
| Corporate Officer | Apr 1, 2023 | ||
| Corporate Director | Apr 26, 2023 | ||
| Michael a Nino | Corporate Officer | Jan 28, 2009 | |
| W-2 Managing Employee | Jan 28, 2009 | ||
| Corporate Director | Jan 1, 2012 | ||
| W-2 Managing Employee | Jan 1, 2012 | ||
| Corporate Officer | Feb 1, 2017 | ||
| W-2 Managing Employee | Feb 1, 2017 | ||
| Corporate Officer | Jan 1, 2022 | ||
| Corporate Director | Jan 28, 2009 | ||
| W-2 Managing Employee | Jan 1, 2022 | ||
| Corporate Director | Jan 28, 2009 | ||
| Corporate Director | Feb 1, 2017 | ||
| Corporate Director | Feb 1, 2017 | ||
| W-2 Managing Employee | Feb 17, 2017 | ||
| Freida R Thompson | Corporate Director | Mar 1, 2018 | |
| Corporate Director | May 16, 2018 | ||
| Mimi Beresky | Corporate Officer | Sep 10, 2010 | |
| W-2 Managing Employee | Sep 10, 2010 | ||
| Corporate Director | Sep 1, 2010 | ||
| Corporate Officer | Sep 1, 2010 | ||
| W-2 Managing Employee | Sep 1, 2010 | ||
| W-2 Managing Employee | Jan 1, 2022 | ||
| Corporate Director | Jan 1, 2022 | ||
| Corporate Director | Sep 1, 2010 | ||
| Corporate Director | Sep 1, 2010 | ||
| Shalom Health Care Center Inc | 5% Or Greater Direct Ownership Interest | Aug 27, 2002 | |
| Operational/Managerial Control | Jan 1, 1990 | 100% | |
| Operational/Managerial Control | Aug 7, 2012 | 100% | |
| Operational/Managerial Control | Aug 1, 2014 | 100% | |
| Casandra Hooks | Corporate Director | Feb 23, 2022 | |
| Corporate Director | Feb 1, 2022 | ||
| Corporate Director | Feb 1, 2022 | ||
| Richard Proctor | Corporate Director | Sep 1, 2022 | |
| Corporate Director | Sep 1, 2022 | ||
| Corporate Director | Sep 28, 2022 | ||
| Arielle Zerger | Corporate Director | Feb 24, 2021 | |
| Corporate Director | Feb 1, 2021 | ||
| Corporate Director | Feb 1, 2021 | ||
| Corporate Director | Feb 24, 2021 | ||
| Eugina Long | Corporate Director | May 17, 2017 | |
| Corporate Director | Mar 1, 2017 | ||
| Corporate Director | Mar 1, 2017 | ||
| Corporate Director | Mar 1, 2017 | ||
| Corporate Director | Mar 1, 2018 | ||
| Corporate Director | Mar 1, 2018 | ||
| Hans Bernabe | Corporate Director | Sep 22, 2021 | |
| Corporate Director | Sep 1, 2021 | ||
| Corporate Director | Sep 1, 2021 | ||
| Corporate Director | Sep 22, 2021 | ||
| Virna Diaz | Corporate Director | Nov 18, 2020 | |
| Corporate Director | Nov 1, 2020 | ||
| Corporate Director | Nov 1, 2020 | ||
| Corporate Director | Nov 18, 2020 | ||
| Cristian Guandique | Corporate Director | Nov 18, 2020 | |
| Cesar Roman | Corporate Director | May 17, 2017 | |
| Lyndsey a Furry | W-2 Managing Employee | Jan 1, 2022 | |
| Kendrea Derrick | Corporate Director | Jul 18, 2018 | |
| Corporate Director | May 17, 2017 | ||
| Denise Hill | Corporate Director | Feb 23, 2022 | |
| Margarita a Wiersema | W-2 Managing Employee | Jan 1, 2022 | |
| Adrian Mason | Corporate Director | May 22, 2024 | |
| Michele Washington | Corporate Director | Jun 26, 2024 |
Owners & managing parties with NPI records 5
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Nurse Practitioner
- Indianapolis, IN
- NPI 1467822536
W-2 Managing Employee
-
dba Shalom 56th Street-New Access Point
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1003275512
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Indianapolis, IN
- NPI 1770267486
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1083806608
W-2 Managing Employee
Practitioners & affiliated clinicians
Practitioners 57
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.
-
- Family Nurse Practitioner
- Indianapolis, IN
- NPI 1164125928
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1295960805
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1609879675
-
- Physician Assistant
- Indianapolis, IN
- NPI 1154891133
-
- Family Nurse Practitioner
- Indianapolis, IN
- NPI 1467822536
-
- Psychiatric/Mental Health Nurse Practitioner
- Franklin, IN
- NPI 1922544584
Family
-
- Specialist
- Indianapolis, IN
- NPI 1407845795
-
- Pediatric Nurse Practitioner
- Indianapolis, IN
- NPI 1760116040
Pediatrics
-
- Family Nurse Practitioner
- Indianapolis, IN
- NPI 1316544166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1774828800000",
"number": "1992924633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 LAFAYETTE ROAD",
"address_2": "SUITE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462221147",
"telephone_number": "317-291-7422",
"fax_number": "317-291-7433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 LAFAYETTE ROAD",
"address_2": "SUITE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462221147",
"telephone_number": "317-291-7422",
"fax_number": "317-291-7433"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHALOM HEALTH CARE CENTER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-24",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A",
"authorized_official_last_name": "ORTEGA",
"authorized_official_first_name": "LEONARDO",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "317-291-7422",
"authorized_official_credential": "M.D., M.P.H."
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200392480",
"state": "IN"
}
],
"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 Mar 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.