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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

ST. MARY ADULT MEDICINE, LLC
NPI 1942481965
General Practice in Indianapolis, IN

Active since November 19, 2007CLIA 15D1053452 · Waiver
4803 W 71ST ST, INDIANAPOLIS, IN 46268(317) 293-9039(855) 538-6177 Get Directions Write a Review

NPPES record last updated: August 15, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 15, 2026, Sep 14, 2016 (2 updates tracked since 2016).

About St. Mary Adult Medicine, Llc NPPES

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

ST. MARY ADULT MEDICINE, LLC (NPI 1942481965) is a healthcare organization registered as a general practice in Indianapolis, Indiana and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through October 27, 2027 and lists Dina M Mourice, Np, as its authorized official.

NPPES Registry Identity

NPI1942481965
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameST. MARY ADULT MEDICINE, LLC
Location Address4803 W 71ST STIndianapolis, IN 46268-2149
Mailing Address4803 W 71st StIndianapolis, IN 46268-2149 · (317) 293-9039 · Fax (855) 538-6177
Phone(317) 293-9039
Fax(855) 538-6177
Organization SubpartNo
Authorized OfficialDina M MouriceNp · (317) 293-9039
Enumeration DateNovember 19, 2007
Last NPPES UpdateAugust 15, 20262 updates tracked since enumeration
NPPES CertifiedAugust 15, 2026
✔ NPI 1942481965 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
4803 W 71ST ST, Indianapolis, IN 46268
Open in Google Maps ↗

Other Identifiers 1

Medicaid201378550IN

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

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 15D1053452

St Mary Adult Medicine · Indianapolis, IN
Active · expires Oct 27, 2027
CLIA Number15D1053452
Laboratory TypePhysician Office
Certificate Effective DateOctober 28, 2025
Certificate Expiration DateOctober 27, 2027
Laboratory DirectorMalak G. Hermina
Laboratory Phone(317) 293-9039
Laboratory LocationSt Mary Adult Medicine5525 Georgetown Rd Ste F, Indianapolis, IN 46254
CLIA data matches this NPI record on: 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 St. Mary Adult Medicine, LLC's NPI number?

The NPI number for St. Mary Adult Medicine, LLC is 1942481965. It was assigned to this organization in the NPPES registry on November 19, 2007.

Where is St. Mary Adult Medicine, LLC located?

St. Mary Adult Medicine, LLC is located at 4803 W 71st St, Indianapolis, IN 46268. The listed phone number is (317) 293-9039.

What is St. Mary Adult Medicine, LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does St. Mary Adult Medicine, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D1053452) is associated with this NPI, valid through October 27, 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 St. Mary Adult Medicine, LLC was last updated on August 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 days 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.