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PREMIER PEDIATRICS OF INDIANA LLC
NPI 1760084156
Pediatrics in Granger, IN

Active since November 11, 2020CLIA 15D2204487 · Waiver
229 FLORENCE AVE STE 233, GRANGER, IN 46530(574) 855-4575 Get Directions Write a Review

NPPES record last updated: July 20, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 20, 2021, Jan 12, 2021, Nov 11, 2020 (3 updates tracked since 2020).

About Premier Pediatrics Of Indiana Llc NPPES

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

PREMIER PEDIATRICS OF INDIANA LLC (NPI 1760084156) is a healthcare organization registered as a pediatrics in Granger, Indiana and active in the NPI registry since November 2020. The organization holds a CLIA Waiver certificate valid through December 8, 2026 and lists Charisse Johnson, Sole Proprietor, as its authorized official.

NPPES Registry Identity

NPI1760084156
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NamePREMIER PEDIATRICS OF INDIANA LLC
Location Address229 FLORENCE AVE STE 233Granger, IN 46530-8048
Mailing Address229 Florence Ave Ste 233Granger, IN 46530-8048 · (574) 855-4575
Phone(574) 855-4575
Organization SubpartNo
Authorized OfficialCharisse JohnsonSole Proprietor · (317) 345-3142
Enumeration DateNovember 11, 2020
Last NPPES UpdateJuly 20, 20213 updates tracked since enumeration
NPPES CertifiedJuly 20, 2021
✔ NPI 1760084156 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
229 FLORENCE AVE STE 233, Granger, IN 46530
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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.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 15D2204487

Premier Pediatrics Of Indiana, LLC · Granger, IN
Active · expires Dec 8, 2026
CLIA Number15D2204487
Laboratory TypePhysician Office
Certificate Effective DateDecember 9, 2024
Certificate Expiration DateDecember 8, 2026
Laboratory DirectorCharisse D. Johnson
Laboratory Phone(574) 855-4575
Laboratory LocationPremier Pediatrics Of Indiana, LLC229 Florence Ave, Ste 233, Granger, IN 46530
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

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

DR. CHARISSE D JOHNSON MD
Pediatrics
229 FLORENCE AVE STE 233
GRANGER, IN 46530
St. Joseph County (574) 855-4575

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 Premier Pediatrics Of Indiana LLC's NPI number?

The NPI number for Premier Pediatrics Of Indiana LLC is 1760084156. It was assigned to this organization in the NPPES registry on November 11, 2020.

Where is Premier Pediatrics Of Indiana LLC located?

Premier Pediatrics Of Indiana LLC is located at 229 Florence Ave Ste 233, Granger, IN 46530. The listed phone number is (574) 855-4575.

What is Premier Pediatrics Of Indiana LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Premier Pediatrics Of Indiana LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2204487) is associated with this NPI, valid through December 8, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Premier Pediatrics Of Indiana LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan and Ambetter from Meridian list Premier Pediatrics Of Indiana 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 Premier Pediatrics Of Indiana LLC was last updated on July 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.