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PRIVIA MEDICAL GROUP INDIANA, LLC
NPI 1730638990
Clinic/Center - Multi-Specialty in Elkhart, IN

Active since September 29, 2016CLIA 15D2123132 · Accreditation
25651 COUNTY ROAD 20, ELKHART, IN 46517(574) 522-1201 Get Directions Write a Review

NPPES record last updated: May 12, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 12, 2025, Sep 29, 2016 (2 updates tracked since 2016).

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 1730638990) is a healthcare organization registered as a multi-specialty in Elkhart, Indiana and active in the NPI registry since September 2016. The organization holds an CLIA Accreditation certificate valid through October 12, 2027 and lists Kevin R Boyer, Ceo, as its authorized official.

NPPES Registry Identity

NPI1730638990
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePRIVIA MEDICAL GROUP INDIANA, LLC
Location Address25651 COUNTY ROAD 20Elkhart, IN 46517-2310
Mailing Address303 S Nappanee StElkhart, IN 46514-2066 · (574) 296-3200 · Fax (574) 296-3392
Phone(574) 522-1201
Organization SubpartNo
Authorized OfficialKevin R BoyerCeo · (574) 296-3254
Enumeration DateSeptember 29, 2016
Last NPPES UpdateMay 12, 20252 updates tracked since enumeration
NPPES CertifiedMay 12, 2025
✔ NPI 1730638990 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
25651 COUNTY ROAD 20, Elkhart, IN 46517
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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 Accreditation 15D2123132

Privia Medical Group Indiana, LLC · Elkhart, IN
Active · expires Oct 12, 2027
CLIA Number15D2123132
Laboratory TypePhysician Office
Certificate Effective DateOctober 13, 2025
Certificate Expiration DateOctober 12, 2027
Laboratory DirectorDr. Ahsanul Haque
Laboratory Phone(574) 296-3368
Laboratory LocationPrivia Medical Group Indiana, LLC25651 County Road 20, Elkhart, IN 46517
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HARLEY WAYNE YODER M.D.
Family Medicine
25651 COUNTY ROAD 20
ELKHART, IN 46517
Elkhart County (574) 522-1201
CONCORD FAMILY MEDICINE PC
Family Medicine
25651 COUNTY ROAD 20
ELKHART, IN 46517
Elkhart County (574) 522-1201
BEACON MEDICAL GROUP INC.
Internal Medicine (Cardiovascular Disease)
25651 COUNTY ROAD 20
ELKHART, IN 46517
Elkhart County (574) 524-7128
HODA RAHMANI MD
Family Medicine
25651 COUNTY ROAD 20
ELKHART, IN 46517
Elkhart County (571) 244-2261

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 1730638990. It was assigned to this organization in the NPPES registry on September 29, 2016.

Where is Privia Medical Group Indiana, LLC located?

Privia Medical Group Indiana, LLC is located at 25651 County Road 20, Elkhart, IN 46517. The listed phone number is (574) 522-1201.

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.

Does Privia Medical Group Indiana, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 15D2123132) is associated with this NPI, valid through October 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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 with the weekly NPPES data releases published by CMS.