LIFELINE MEDICAL CENTER
Complete NPI Record 1265160451
Family Medicine in Anderson, IN
Active since August 15, 2022CLIA Certified · 2 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Lifeline Medical Center (NPI 1265160451), a family medicine organization in Anderson, IN. All 43 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1265160451 Field 1/43
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/43
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/43
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: LIFELINE MEDICAL CENTER Field 4/43
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 3159 CARPENTERS PARK RD Field 5/43
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: DAVIDSVILLE Field 6/43
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: PA Field 7/43
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 159289223 Field 8/43
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/43
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 8144080014 Field 10/43
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 8144795906 Field 11/43
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 2101 JACKSON ST STE 109 Field 12/43
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: ANDERSON Field 13/43
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IN Field 14/43
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 460164386 Field 15/43
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/43
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 8144080014 Field 17/43
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: GRIESHEIMER Field 20/43
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: PATRICIA Field 21/43
- The first name of the authorized official.
- Authorized Official Title or Position: COO Field 22/43
- The title or position of the authorized official.
- Authorized Official Telephone Number: 8142430414 Field 23/43
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 101YM0800X Field 24/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 25/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 101YP2500X Field 26/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 27/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 207Q00000X Field 28/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: Y Field 29/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 363LF0000X Field 30/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: N Field 31/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 5: 363LP0808X Field 32/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 5: N Field 33/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 99999999999 Field 34/43
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 35/43
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: OR Field 36/43
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 37/43
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 38/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP Field 39/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 40/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP Field 41/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP Field 42/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 26
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
500 Galleria Dr
Location 1/26Johnstown, PA 15904-8906 · Phone (814) 408-0014
35200 Dequindre Rd
Location 2/26Sterling Heights, MI 48310-4837 · Phone (814) 408-0014
23077 Greenfield Rd Ste 455
Location 3/26Southfield, MI 48075-3740 · Phone (814) 408-0014
1415 W 22nd St
Location 4/26Oak Brook, IL 60523-2074 · Phone (814) 408-0014
6565 Americas Pkwy NE Ste 200
Location 5/26Albuquerque, NM 87110-8172 · Phone (814) 408-0014
3415 S Sepulveda Blvd Ste 1100
Location 6/26Los Angeles, CA 90034-7090 · Phone (814) 408-0014
1915 NE Stucki Ave Ste 400
Location 7/26Hillsboro, OR 97006-6938 · Phone (814) 408-0014
701 NE 136th Ave Ste 200
Location 8/26Vancouver, WA 98684-6937 · Phone (814) 408-0014
2900 Westfork Dr Ste 401
Location 9/26Baton Rouge, LA 70827-0004 · Phone (814) 408-0014
10121 SE Sunnyside Rd
Location 10/26Clackamas, OR 97015-5745 · Phone (814) 409-0014
3707 E Southern Ave Ste 1025
Location 11/26Mesa, AZ 85206-6202 · Phone (814) 408-0014
41 University Dr Ste 400
Location 12/26Newtown, PA 18940-1873 · Phone (814) 408-0014
13509 Lyndon B Johnson Fwy Ste 200
Location 13/26Garland, TX 75041-4704 · Phone (814) 408-0014
2245 Texas Dr Ste 300
Location 14/26Sugar Land, TX 77479-1468 · Phone (814) 408-0014
2000 Town Ctr Ste 1900
Location 15/26Southfield, MI 48075-1152 · Phone (814) 408-0014 · Fax (814) 479-5906
1500 NW Bethany Blvd Ste 200
Location 16/26Beaverton, OR 97006-5236 · Phone (814) 408-0014 · Fax (503) 914-6422
2180 Satellite Blvd Ste 400
Location 17/26Duluth, GA 30097-4927 · Phone (814) 408-0014
8875 Hidden River Pkwy Ste 300
Location 18/26Tampa, FL 33637-2087 · Phone (814) 408-0014
3597 E Monarch Sky Ln Ste 240
Location 19/26Meridian, ID 83646-1055 · Phone (814) 408-0014
698 12th St SE Ste 240-5
Location 20/26Salem, OR 97301-4039 · Phone (814) 408-0014
1925 NE Stucki Ave
Location 21/26Hillsboro, OR 97006-6945 · Phone (814) 408-0014
2101 Jackson St
Location 22/26Anderson, IN 46016-4388 · Phone (814) 408-0014
1201 Pacific Ave Ste 6
Location 23/26Tacoma, WA 98402-4393 · Phone (814) 408-0014
321 Main St
Location 24/26Johnstown, PA 15901-1632 · Phone (814) 408-0014
2855 Charlestown Rd Ste 300
Location 25/26New Albany, IN 47150-2691 · Phone (814) 408-0014
3159 Carpenters Park Rd
Location 26/26Davidsville, PA 15928-9223 · Phone (814) 408-0014
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
99999999999 Medicaid
Identifier 1/1State: OR
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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