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

Q: 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.

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

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

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: October 18, 2026.

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

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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

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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

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 and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

St. Mary Adult Medicine, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to St. Mary Adult Medicine, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Malak Hermina, MD FACP

Internal Medicine

NPI 1366496119

4803 W 71ST ST
Indianapolis, IN 46268

(317) 293-9039

✔ PECOS✔ Accepts MedicareSame address

Dina Mourice, AGNP-C

Nurse Practitioner

NPI 1619336096

4803 W 71ST ST
Indianapolis, IN 46268

(317) 293-9039

✔ PECOS✔ Accepts MedicareSame address

Source: 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 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 Medicine4803 W 71st Street, Indianapolis, IN 46268

CLIA data matches this NPI record on: Address 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.

Is St. Mary Adult Medicine, LLC enrolled in Medicare?

Yes. St. Mary Adult Medicine, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through St. Mary Adult Medicine, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to St. Mary Adult Medicine, LLC, in Internal Medicine and Nurse Practitioner. 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

What insurance does St. Mary Adult Medicine, LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list St. Mary Adult Medicine, 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 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 2 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.