PRIVIA MEDICAL GROUP INDIANA, LLC
NPI 1730638990
Clinic/Center - Multi-Specialty in Elkhart, IN
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
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Privia Medical Group Indiana, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
47Medicare enrollment records show 47 clinicians reassign Medicare billing to Privia Medical Group Indiana, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 33 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 19
Nearest to this location (20)
See all 47Source: 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 Accreditation 15D2123132
Privia Medical Group Indiana, LLC · Elkhart, 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 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.
Is Privia Medical Group Indiana, LLC enrolled in Medicare?
Yes. Privia Medical Group Indiana, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Privia Medical Group Indiana, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 47 clinicians in 19 Medicare specialties reassign their Medicare billing to Privia Medical Group Indiana, LLC. 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 (12), Family Practice (10) and Internal Medicine (6). Of these, 1 practice at this address and 33 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Privia Medical Group Indiana, Llc · NPI 1730638990
Multi-Specialty organization in Elkhart, Indiana. Organization record, active in the CMS NPPES registry since September 29, 2016.
## Identity
- **NPI:** 1730638990 (Entity type: Organization)
- **Enumerated:** September 29, 2016
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Organization subpart:** No
- **Authorized official:** Kevin Boyer, CEO
## Practice location
- **Address:** 25651 COUNTY ROAD 20, Elkhart, IN 46517-2310
- **Phone:** (574) 522-1201
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 47 clinicians in 19 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (12), Family Practice (10), Internal Medicine (6); 1 practice at this address and 33 within 10 miles; [full list](https://npiprofile.com/npi/1730638990/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 12, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1730638990) · Data from the CMS NPPES public registry.