AGELESS MINDS LLC
NPI 1104769611
Clinical Nurse Specialist - Psychiatric/Mental Health in Indianapolis, IN
About Ageless Minds Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
AGELESS MINDS LLC (NPI 1104769611) is a healthcare organization registered as a psychiatric/mental health in Indianapolis, Indiana and active in the NPI registry since April 2026. The organization lists Queela Tadoum, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ageless Minds Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Ageless Minds LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Ageless Minds LLC's NPI number?
The NPI number for Ageless Minds LLC is 1104769611. It was assigned to this organization in the NPPES registry on April 10, 2026.
Where is Ageless Minds LLC located?
Ageless Minds LLC is located at 9165 Otis Ave Ste 164, Indianapolis, IN 46216. The listed phone number is (317) 930-1557.
What is Ageless Minds LLC's specialty?
The primary specialty registered for this NPI is Clinical Nurse Specialist, specializing in Psychiatric/Mental Health, with taxonomy code 364SP0808X.
Is Ageless Minds LLC enrolled in Medicare?
Yes. Ageless Minds LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ageless Minds LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Certified Clinical Nurse Specialist (CNS)) reassigns their Medicare billing to Ageless Minds 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Ageless Minds LLC was last updated on April 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Ageless Minds Llc · NPI 1104769611
Psychiatric/Mental Health organization in Indianapolis, Indiana. Organization record, active in the CMS NPPES registry since April 10, 2026.
## Identity
- **NPI:** 1104769611 (Entity type: Organization)
- **Enumerated:** April 10, 2026
- **Primary specialty:** Clinical Nurse Specialist - Psychiatric/Mental Health · taxonomy 364SP0808X
- **Organization subpart:** No
- **Authorized official:** Queela Tadoum, OWNER
## Practice location
- **Address:** 9165 OTIS AVE STE 164, Indianapolis, IN 46216-2312
- **Phone:** (317) 930-1557
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Certified Clinical Nurse Specialist (CNS)) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 10, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1104769611) · Data from the CMS NPPES public registry.