CENTERWELL SENIOR PRIMARY CARE-COLLEGE PARK
NPI 1396511648
Internal Medicine in Indianapolis, IN
About Centerwell Senior Primary Care-college Park NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CENTERWELL SENIOR PRIMARY CARE-COLLEGE PARK (NPI 1396511648) is a healthcare organization registered as an internal medicine in Indianapolis, Indiana and active in the NPI registry since November 2023. The organization holds a CLIA Waiver certificate valid through May 9, 2028 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
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)
Centerwell Senior Primary Care-college Park is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
42Medicare enrollment records show 42 clinicians reassign Medicare billing to Centerwell Senior Primary Care-College Park, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 9 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 4
Nearest to this location (20)
See all 42Source: 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 Waiver 15D2304300
Centerwell Senior Primary Care-College Park · Indianapolis, INFrequently 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 Centerwell Senior Primary Care In PC's NPI number?
The NPI number for Centerwell Senior Primary Care In PC is 1396511648. It was assigned to this organization in the NPPES registry on November 28, 2023. The provider is doing business as Centerwell Senior Primary Care-College Park.
Where is Centerwell Senior Primary Care In PC located?
Centerwell Senior Primary Care In PC is located at 2902 W 86th St, Indianapolis, IN 46268. The listed phone number is (407) 447-7120.
What is Centerwell Senior Primary Care In PC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Centerwell Senior Primary Care In PC enrolled in Medicare?
Yes. Centerwell Senior Primary Care In PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Centerwell Senior Primary Care In PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 42 clinicians in 4 Medicare specialties reassign their Medicare billing to Centerwell Senior Primary Care In PC. 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 (13), Cardiovascular Disease (Cardiology) (11) and Family Practice (11). Of these, 4 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Centerwell Senior Primary Care In PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 15D2304300) is associated with this NPI, valid through May 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Centerwell Senior Primary Care In PC was last updated on July 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.
# Centerwell Senior Primary Care-College Park · NPI 1396511648
Internal Medicine organization in Indianapolis, Indiana. Organization record, active in the CMS NPPES registry since November 28, 2023.
## Identity
- **NPI:** 1396511648 (Entity type: Organization)
- **Enumerated:** November 28, 2023
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** Centerwell Senior Primary Care In Pc
- **Organization subpart:** Yes (part of Centerwell Senior Primary Care In Pc)
- **Authorized official:** Angie Martinez, SENIOR CREDENTIALING PROFESSIONAL
## Practice location
- **Address:** 2902 W 86TH ST, Indianapolis, IN 46268-5900
- **Phone:** (407) 447-7120
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 42 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (13), Cardiovascular Disease (Cardiology) (11), Family Practice (11); 4 practice at this address and 9 within 10 miles; [full list](https://npiprofile.com/npi/1396511648/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 1, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1396511648) · Data from the CMS NPPES public registry.