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PRIVIA MEDICAL GROUP INDIANA, LLC
NPI 1013380526
Ophthalmology in Elkhart, IN

Active since November 05, 2015CLIA Certified · 3 labs
2222 W LEXINGTON AVE, ELKHART, IN 46514(574) 294-3030(574) 296-3544 Get Directions Write a Review

NPPES record last updated: May 12, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 12, 2025, Jan 2, 2024, Nov 27, 2018 and 1 more (4 updates tracked since 2017).

About Privia Medical Group Indiana, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRIVIA MEDICAL GROUP INDIANA, LLC (NPI 1013380526), doing business as Elkhart Eye Care, is a healthcare organization registered as an ophthalmology in Elkhart, Indiana and active in the NPI registry since November 2015. The organization holds 3 active CLIA laboratory certificates and lists Thomas Vandergrift, Ceo, as its authorized official.

NPPES Registry Identity

NPI1013380526
Entity TypeOrganization
Primary Taxonomy207W00000X
Legal Business NamePRIVIA MEDICAL GROUP INDIANA, LLC
Location Address2222 W LEXINGTON AVEElkhart, IN 46514-1420
Mailing AddressPo Box 2968Elkhart, IN 46515-2968 · (574) 296-3200 · Fax (574) 296-3392
Phone(574) 294-3030
Fax(574) 296-3544
Organization SubpartNo
Authorized OfficialThomas VandergriftCeo · (574) 296-3200
Enumeration DateNovember 5, 2015
Last NPPES UpdateMay 12, 20254 updates tracked since enumeration
NPPES CertifiedMay 12, 2025
✔ NPI 1013380526 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
Definition

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

2222 W LEXINGTON AVE, Elkhart, IN 46514
Open in Google Maps ↗

Other Names 1

Doing Business AsElkhart Eye Care

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2307515

Privia Medical Group Indiana, LLC · Elkhart, IN
Active · expires Jul 9, 2028
CLIA Number15D2307515
Laboratory TypePhysician Office
Certificate Effective DateJuly 10, 2026
Certificate Expiration DateJuly 9, 2028
Laboratory DirectorBancy Mwangi
Laboratory Phone(574) 296-3368
Laboratory LocationPrivia Medical Group Indiana, LLC2222 W Lexington Ave, Elkhart, IN 46514
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 15D0682018

Privia Medical Group Indiana · Elkhart, IN
Active · expires Dec 22, 2027
CLIA Number15D0682018
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2025
Certificate Expiration DateDecember 22, 2027
Laboratory DirectorDr. Ahsanul Haque
Laboratory Phone(574) 296-3368
Laboratory LocationPrivia Medical Group Indiana303 S Nappanee St, Elkhart, IN 46514
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 15D0356530

Privia Medical Group Indiana, LLC · Elkhart, IN
Active · expires Aug 31, 2026
CLIA Number15D0356530
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorAaron Young
Laboratory Phone(574) 296-3368
Laboratory LocationPrivia Medical Group Indiana, LLC2115 W Lexington, Elkhart, IN 46514
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JAMES E. GLUCKIN M.D.
Ophthalmology
2222 W LEXINGTON AVE
ELKHART, IN 46514
Elkhart County (574) 294-3030
PRIVIA MEDICAL GROUP INDIANA, LLC
Clinic/Center (Multi-Specialty)
2222 W LEXINGTON AVE, SUITE B
ELKHART, IN 46514
Elkhart County (574) 296-3200
DR. MELISSA A HENDERSON O.D
Optometrist
2222 W LEXINGTON AVE
ELKHART, IN 46514
Elkhart County (574) 294-3030
KENNETH W ABBOTT MD
Ophthalmology
2222 W LEXINGTON AVE
ELKHART, IN 46514
Elkhart County (574) 294-3030
ABBOTT EYE CLINIC INC PC
Ophthalmology
2222 W LEXINGTON AVE
ELKHART, IN 46514
Elkhart County (574) 294-3030

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Privia Medical Group Indiana, LLC's NPI number?

The NPI number for Privia Medical Group Indiana, LLC is 1013380526. It was assigned to this organization in the NPPES registry on November 5, 2015. The provider is doing business as Elkhart Eye Care.

Where is Privia Medical Group Indiana, LLC located?

Privia Medical Group Indiana, LLC is located at 2222 W Lexington Ave, Elkhart, IN 46514. The listed phone number is (574) 294-3030.

What is Privia Medical Group Indiana, LLC's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Does Privia Medical Group Indiana, LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Privia Medical Group Indiana, LLC was last updated on May 12, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.