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PRIVIA MEDICAL GROUP INDIANA, LLC
NPI 1235303165
Clinic/Center - Multi-Specialty in Mishawaka, IN

Active since April 22, 2008
410 PARK PL, SUITE B, MISHAWAKA, IN 46545(574) 855-5800(574) 855-5805 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, Jul 15, 2020 (2 updates tracked since 2020).

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 1235303165) is a healthcare organization registered as a multi-specialty in Mishawaka, Indiana and active in the NPI registry since April 2008. The organization lists Timothy Porsche, Managing Partner, as its authorized official.

NPPES Registry Identity

NPI1235303165
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePRIVIA MEDICAL GROUP INDIANA, LLC
Location Address410 PARK PL, SUITE BMishawaka, IN 46545-3557
Mailing AddressPo Box 2968Elkhart, IN 46515-2968 · (574) 296-3200 · Fax (574) 296-3392
Phone(574) 855-5800
Fax(574) 855-5805
Organization SubpartNo
Authorized OfficialTimothy PorscheManaging Partner · (574) 296-3200
Enumeration DateApril 22, 2008
Last NPPES UpdateMay 12, 20252 updates tracked since enumeration
NPPES CertifiedMay 12, 2025
✔ NPI 1235303165 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
410 PARK PL, Mishawaka, IN 46545
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Other Names 2

Other NameEdison Lakes Urology
Other NamePrimary Care At Mishawaka

Other Identifiers 2

Medicaid100466600DIN
Other0359310002IN · Medicare Nsc

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 1235303165. It was assigned to this organization in the NPPES registry on April 22, 2008. The provider is also known as Edison Lakes Urology and Primary Care at Mishawaka.

Where is Privia Medical Group Indiana, LLC located?

Privia Medical Group Indiana, LLC is located at 410 Park Pl Suite B, Mishawaka, IN 46545. The listed phone number is (574) 855-5800.

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.

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.