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

Active since November 05, 2015CLIA 15D0682018 · Accreditation
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: October 18, 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 an CLIA Accreditation certificate valid through December 22, 2027 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
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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Privia Medical Group Indiana, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

47

Medicare enrollment records show 47 clinicians reassign Medicare billing to Privia Medical Group Indiana, LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 33 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 19

Nurse Practitioner12
Family Practice10
Internal Medicine6
Gastroenterology2
General Surgery2
Podiatry2
Allergy/Immunology1
Anesthesiology1
11 other specialties11

Nearest to this location (20)

See all 47
Nicole Graves, NP
Nurse Practitioner
NPI 1386135374
2222 W LEXINGTON AVE STE B
Elkhart, IN 46514
(574) 296-3348
✔ PECOS✔ Accepts MedicareSame address
Melissa Henderson, O.D
Optometry
NPI 1376982074
2222 W LEXINGTON AVE
Elkhart, IN 46514
(574) 294-3030
✔ PECOS✔ Accepts MedicareSame address
Katarina Moskalow, M.D.
Family Practice
NPI 1508508706
2115 W LEXINGTON AVE
Elkhart, IN 46514
(574) 296-3200
✔ PECOS✔ Accepts MedicareSame address
Heather Macklem, M.D.
Family Practice
NPI 1588667117
2115 W LEXINGTON AVE
Elkhart, IN 46514
(574) 296-3955
✔ PECOS✔ Accepts Medicare0.1 mi
Ryan Matherly, M.D.
Family Practice
NPI 1356344972
2115 W LEXINGTON AVE
Elkhart, IN 46514
(574) 296-3955
✔ PECOS0.1 mi
Dayna Gerring, FNP-BC
Nurse Practitioner
NPI 1184010936
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3200
✔ PECOS✔ Accepts Medicare0.1 mi
Eric Johnson, M.D.
Otolaryngology
NPI 1245201169
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3291
✔ PECOS✔ Accepts Medicare0.1 mi
Matthew Abrell, DPM
Podiatry
NPI 1164917167
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3200
✔ PECOS✔ Accepts Medicare0.1 mi
Pavan Ahuja, M.D.
Internal Medicine
NPI 1578566675
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3307
✔ PECOS✔ Accepts Medicare0.1 mi
William Buckley, M.D.
Internal Medicine
NPI 1922001098
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3314
✔ PECOS✔ Accepts Medicare0.1 mi
Matthew Deere
General Surgery
NPI 1952797771
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3200
✔ PECOS✔ Accepts Medicare0.1 mi
Kenneth Gammon, M.D.
Pulmonary Disease
NPI 1528061447
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3314
✔ PECOS✔ Accepts Medicare0.1 mi
Gordon Hughes, MD
Rheumatology
NPI 1003895681
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3200
✔ PECOS✔ Accepts Medicare0.1 mi
Mamoon Raza, M.D.
Gastroenterology
NPI 1326098013
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3341
✔ PECOS✔ Accepts Medicare0.1 mi
Geoffrey Rogers, M.D.
Allergy/Immunology
NPI 1265437255
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3314
✔ PECOS✔ Accepts Medicare0.1 mi
Thomas Vidic, M.D.
Neurology
NPI 1265437404
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3282
✔ PECOS✔ Accepts Medicare0.1 mi
Luisito Gonzales, M.D.
Cardiovascular Disease (Cardiology)
NPI 1164425997
303 S NAPPANEE ST STE A
Elkhart, IN 46514
(574) 296-3466
✔ PECOS✔ Accepts Medicare0.3 mi
Nazmul Huda, MD
Interventional Cardiology
NPI 1609076777
303 S NAPPANEE ST STE A
Elkhart, IN 46514
(574) 296-3338
✔ PECOS✔ Accepts Medicare0.3 mi
Erin Schnittger, FNP-C
Nurse Practitioner
NPI 1316883879
303 S NAPPANEE ST
Elkhart, IN 46514
(574) 296-3200
✔ PECOS0.3 mi
Tiffany Szymarek, MD
Ophthalmology
NPI 1336362318
1628 W BEARDSLEY AVE
Elkhart, IN 46514
(574) 391-1020
✔ PECOS✔ Accepts Medicare0.7 mi
See all 47 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

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 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.

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.

Is Privia Medical Group Indiana, LLC enrolled in Medicare?

Yes. Privia Medical Group Indiana, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Privia Medical Group Indiana, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 47 clinicians in 19 Medicare specialties reassign their Medicare billing to Privia Medical Group Indiana, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (12), Family Practice (10) and Internal Medicine (6). Of these, 3 practice at this address and 33 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Privia Medical Group Indiana, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 15D0682018) is associated with this NPI, valid through December 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.