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SUPRO DIRECT
NPI 1750829230
Family Medicine in Greenwood, IN

Active since February 06, 2017CLIA 15D2126074 · Waiver
701 E COUNTY LINE RD, SUITE 210, GREENWOOD, IN 46143(317) 300-7424(317) 360-7976 Get Directions Write a Review

NPPES record last updated: October 9, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 9, 2023, Feb 7, 2017 (2 updates tracked since 2017).

About Supro Direct NPPES

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

SUPRO DIRECT (NPI 1750829230) is a healthcare organization registered as a family medicine in Greenwood, Indiana and active in the NPI registry since February 2017. The organization holds a CLIA Waiver certificate valid through February 19, 2027 and lists Praveen Rajanahalli, Tin Owner, as its authorized official.

NPPES Registry Identity

NPI1750829230
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameALTUS DIRECT, LLC
Location Address701 E COUNTY LINE RD, SUITE 210Greenwood, IN 46143-1072
Mailing Address701 E County Line Rd, Suite 210Greenwood, IN 46143-1072 · (317) 300-7424 · Fax (317) 360-6245
Phone(317) 300-7424
Fax(317) 360-7976
Organization SubpartNo
Authorized OfficialPraveen RajanahalliTin Owner · (317) 300-7424
Enumeration DateFebruary 6, 2017
Last NPPES UpdateOctober 9, 20232 updates tracked since enumeration
NPPES CertifiedOctober 9, 2023
✔ NPI 1750829230 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
701 E COUNTY LINE RD, Greenwood, IN 46143
Open in Google Maps ↗

Other Names 1

Doing Business AsSupro Direct

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.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 15D2126074

Supro Direct · Greenwood, IN
Active · expires Feb 19, 2027
CLIA Number15D2126074
Laboratory TypePhysician Office
Certificate Effective DateFebruary 20, 2025
Certificate Expiration DateFebruary 19, 2027
Laboratory DirectorPraveen Rajanahalli
Laboratory Phone(317) 300-7424
Laboratory LocationSupro Direct701 E County Line Rd Ste 210, Greenwood, IN 46143
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

DR. ABHINAV SINGH MD
Internal Medicine
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2860
HANNAH E MASON FNP
Nurse Practitioner (Family)
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2860
EDRIS AYOUBI M.D.
Hospitalist
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2860
KRISTEN MOUNCE FNP
Nurse Practitioner (Family)
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2860
COURTNEY NELSON AGPCNP-C
Nurse Practitioner (Gerontology)
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2860
DR. RUXANDRA C IONESCU MD
Internal Medicine (Pulmonary Disease)
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2334
DR. JAMES C. WEBB M.D.
Family Medicine
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 883-4736
EHAB WANAS M.D.
Hospitalist
701 E COUNTY LINE RD, SUITE 101
GREENWOOD, IN 46143
Johnson County (317) 885-2860

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 Altus Direct, LLC's NPI number?

The NPI number for Altus Direct, LLC is 1750829230. It was assigned to this organization in the NPPES registry on February 6, 2017. The provider is doing business as Supro Direct.

Where is Altus Direct, LLC located?

Altus Direct, LLC is located at 701 E County Line Rd Suite 210, Greenwood, IN 46143. The listed phone number is (317) 300-7424.

What is Altus Direct, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Altus Direct, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2126074) is associated with this NPI, valid through February 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Altus Direct, LLC accept?

Health plans from CareSource list Altus Direct, LLC 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 Altus Direct, LLC was last updated on October 9, 2023. 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.