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PRIVIA MEDICAL GROUP INDIANA, LLC
NPI 1083165708
Clinic/Center - Multi-Specialty in Elkhart, IN

Active since October 18, 2016
2222 W LEXINGTON AVE, SUITE B, ELKHART, IN 46514(574) 296-3200(574) 296-3392 Get Directions Write a Review

NPPES record last updated: May 12, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 12, 2025, Mar 5, 2024, Aug 19, 2019 and 3 more (6 updates tracked since 2016).

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 1083165708) is a healthcare organization registered as a multi-specialty in Elkhart, Indiana and active in the NPI registry since October 2016. The organization lists Thomas Vandergrift, Ceo, as its authorized official.

NPPES Registry Identity

NPI1083165708
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePRIVIA MEDICAL GROUP INDIANA, LLC
Location Address2222 W LEXINGTON AVE, SUITE BElkhart, IN 46514-1420
Mailing Address303 S Nappanee StElkhart, IN 46514-2066 · (574) 296-3200 · Fax (574) 296-3392
Phone(574) 296-3200
Fax(574) 296-3392
Organization SubpartNo
Authorized OfficialThomas VandergriftCeo · (574) 296-3200
Enumeration DateOctober 18, 2016
Last NPPES UpdateMay 12, 20256 updates tracked since enumeration
NPPES CertifiedMay 12, 2025
✔ NPI 1083165708 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
2222 W LEXINGTON AVE, Elkhart, IN 46514
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Other Names 1

Other NameElkhart Clinic

Medical Equipment Supplier Medicare DMEPOS 2

Medicare supplier enrollment and the product categories Elkhart Clinic, LLC carries, from the Medicare DMEPOS supplier directory.

Elkhart Clinic, LLC

DMEPOS supplier · Elkhart, IN
✔

Accepts Medicare assignment

Elkhart Clinic, LLC agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20664239
Medicare Participant SinceJanuary 1, 1998
Supplier Location2222 W Lexington AveElkhart, IN 46514
Phone(574) 294-3030
Provider TypePhysician – Ophthalmology
Supplier Specialties
Optometrist Optician

Medicare Product Categories

Prosthetic Lenses: Conventional Eyeglasses
Conventional Eyeglasses
Prosthetic Lenses: Conventional Contact Lenses
Conventional Contact Lenses
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

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.

PRIVIA MEDICAL GROUP INDIANA, LLC
Ophthalmology
2222 W LEXINGTON AVE
ELKHART, IN 46514
Elkhart County (574) 294-3030
DR. JAMES E. GLUCKIN M.D.
Ophthalmology
2222 W LEXINGTON AVE
ELKHART, IN 46514
Elkhart County (574) 294-3030
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 1083165708. It was assigned to this organization in the NPPES registry on October 18, 2016. The provider is also known as Elkhart Clinic.

Where is Privia Medical Group Indiana, LLC located?

Privia Medical Group Indiana, LLC is located at 2222 W Lexington Ave Suite B, Elkhart, IN 46514. The listed phone number is (574) 296-3200.

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

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Privia Medical Group Indiana, LLC accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Elkhart Clinic, LLC accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

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 15 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.