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INDIANA SPORTS & MEDICAL SCIENCE INSTITUTE, PC
NPI 1609155290
Clinic/Center in Crown Point, IN

Active since August 12, 2011CLIA 15D2029164 · Waiver
11275 DELAWARE PKWY STE A, CROWN POINT, IN 46307(219) 779-8735(877) 715-2312 Get Directions Write a Review

NPPES record last updated: July 11, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Indiana Sports & Medical Science Institute, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INDIANA SPORTS & MEDICAL SCIENCE INSTITUTE, PC (NPI 1609155290) is a healthcare organization registered as a clinic/center in Crown Point, Indiana and active in the NPI registry since August 2011. The organization holds a CLIA Waiver certificate valid through August 31, 2027 and lists Timothy James Mullaly, Owner, as its authorized official.

NPPES Registry Identity

NPI1609155290
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameINDIANA SPORTS & MEDICAL SCIENCE INSTITUTE, PC
Location Address11275 DELAWARE PKWY STE ACrown Point, IN 46307-7812
Mailing AddressPo Box 108Crown Point, IN 46308-0108 · (219) 662-5530 · Fax (219) 662-1365
Phone(219) 779-8735
Fax(877) 715-2312
Organization SubpartNo
Authorized OfficialTimothy James MullalyOwner · (810) 814-2661
Enumeration DateAugust 12, 2011
Last NPPES UpdateJuly 11, 2022
NPPES CertifiedJuly 11, 2022
✔ NPI 1609155290 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in IN · 02003099A
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
11275 DELAWARE PKWY STE A, Crown Point, IN 46307
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

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 15D2029164

Indiana Sports & Medical Science Institute, PC · Crown Point, IN
Active · expires Aug 31, 2027
CLIA Number15D2029164
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2025
Certificate Expiration DateAugust 31, 2027
Laboratory DirectorTimothy J. Mullally
Laboratory Phone(219) 779-8735
Laboratory LocationIndiana Sports & Medical Science Institute, PC11275 Delaware Parkway, Crown Point, IN 46307
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Indiana Sports & Medical Science Institute, PC's NPI number?

The NPI number for Indiana Sports & Medical Science Institute, PC is 1609155290. It was assigned to this organization in the NPPES registry on August 12, 2011.

Where is Indiana Sports & Medical Science Institute, PC located?

Indiana Sports & Medical Science Institute, PC is located at 11275 Delaware Pkwy Ste A, Crown Point, IN 46307. The listed phone number is (219) 779-8735.

What is Indiana Sports & Medical Science Institute, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Indiana Sports & Medical Science Institute, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2029164) is associated with this NPI, valid through August 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Indiana Sports & Medical Science Institute, PC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and CareSource list Indiana Sports & Medical Science Institute, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Indiana Sports & Medical Science Institute, PC was last updated on July 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.