| Heart City Health Center, Inc. | |
|
236 Simpson Ave Elkhart IN 46516-4666 | |
| (574) 970-1435 | |
| (574) 970-3255 |
| Full Name | Heart City Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 236 Simpson Ave, Elkhart, Indiana |
| Authorized Official Name and Position | Esleen E Fultz (CEO) |
| Authorized Official Contact | 5749703257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart City Health Center, Inc. 236 Simpson Ave Elkhart IN 46516-4666 Ph: (574) 970-7954 | Heart City Health Center, Inc. 236 Simpson Ave Elkhart IN 46516-4666 Ph: (574) 970-1435 |
| NPI Number | 1720033418 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 08/27/2019 |
| Medicare PECOS PAC ID | 9931008380 |
|---|---|
| Medicare Enrollment ID | O20040105000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720033418 | NPI | - | NPPES |
| 100097610A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (Indiana) | Primary |
| Provider Name | Mary P Mcmanmon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255363172 PECOS PAC ID: 8325937949 Enrollment ID: I20040312000162 |
| Provider Name | Michael Pao-chun Hu |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1114909942 PECOS PAC ID: 5890768212 Enrollment ID: I20040814000141 |
| Provider Name | Bethany L Mcdaniel-vanderzwaag |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639178650 PECOS PAC ID: 8325090210 Enrollment ID: I20050218000687 |
| Provider Name | Martina Green-mcgowan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295739639 PECOS PAC ID: 0042258360 Enrollment ID: I20050427001269 |
| Provider Name | Jo L Swart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952464257 PECOS PAC ID: 7416044334 Enrollment ID: I20071024000517 |
| Provider Name | Theresa A Bubenzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811025703 PECOS PAC ID: 9335223023 Enrollment ID: I20080219000519 |
| Provider Name | Bethany A Wait |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447458096 PECOS PAC ID: 6002972544 Enrollment ID: I20090306000493 |
| Provider Name | Amalie B Hickman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295917656 PECOS PAC ID: 5698960029 Enrollment ID: I20101111000581 |
| Provider Name | Carol J Mann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487644175 PECOS PAC ID: 8527231646 Enrollment ID: I20111104000096 |
| Provider Name | Kenneth S Bethel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194093807 PECOS PAC ID: 3375719594 Enrollment ID: I20120110000090 |
| Provider Name | Melissa Kay Schiffli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366691198 PECOS PAC ID: 9234387374 Enrollment ID: I20120914000757 |
| Provider Name | Samuel D Kobba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811211154 PECOS PAC ID: 0941432918 Enrollment ID: I20140407001727 |
| Provider Name | Darren Robert Dolly |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750601175 PECOS PAC ID: 3971720277 Enrollment ID: I20140811001076 |
| Provider Name | Nicole L Hartman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457631962 PECOS PAC ID: 8921268665 Enrollment ID: I20140822002417 |
| Provider Name | Heather A Hostetler |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1497154561 PECOS PAC ID: 1951520022 Enrollment ID: I20140923000394 |
| Provider Name | Rocio Ahuja |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1699057976 PECOS PAC ID: 2264603125 Enrollment ID: I20160425002539 |
| Provider Name | Song I Baek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679020119 PECOS PAC ID: 2163701160 Enrollment ID: I20161115001906 |
| Provider Name | Andrea L Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508304304 PECOS PAC ID: 9739456955 Enrollment ID: I20170518001365 |
| Provider Name | Essam A Montasir |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073681524 PECOS PAC ID: 7618062274 Enrollment ID: I20170810001975 |
| Provider Name | Angelina T Panford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437698271 PECOS PAC ID: 1355614116 Enrollment ID: I20170830002748 |
| Provider Name | Lorraine D Swartzentruber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033633656 PECOS PAC ID: 0244503019 Enrollment ID: I20170830002863 |
| Provider Name | Nizar Fayez Olabi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023004504 PECOS PAC ID: 3274529409 Enrollment ID: I20180103000320 |
| Provider Name | Eilee Wah Zhu |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1740792019 PECOS PAC ID: 5597024638 Enrollment ID: I20180117000959 |
| Provider Name | Samantha Lynn Jester |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1275041865 PECOS PAC ID: 0749540565 Enrollment ID: I20180427000393 |
| Provider Name | Aisha Siddiqui |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1972713386 PECOS PAC ID: 8729153721 Enrollment ID: I20181119000592 |
| Provider Name | Nadzieja N Pocheki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053803965 PECOS PAC ID: 9638421597 Enrollment ID: I20190114001856 |
| Provider Name | Nicole Lynn Schwanz |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1043785272 PECOS PAC ID: 8426394156 Enrollment ID: I20190116002688 |
| Provider Name | Lora D Defreese |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1336618644 PECOS PAC ID: 4880931021 Enrollment ID: I20190128000138 |
| Provider Name | Joshua Douglas Majerus |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1992361158 PECOS PAC ID: 0143552315 Enrollment ID: I20191022000755 |
| Provider Name | Julie Beth Motycka |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821009259 PECOS PAC ID: 4688861073 Enrollment ID: I20200814000496 |
| Provider Name | Cecilia M Maina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023640117 PECOS PAC ID: 6709206253 Enrollment ID: I20201021003003 |
| Provider Name | Willard Keith Cupp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265021406 PECOS PAC ID: 3173937299 Enrollment ID: I20210202001233 |
| Provider Name | Elizabeth W Maina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013505668 PECOS PAC ID: 7315351251 Enrollment ID: I20210204000438 |
| Provider Name | Pompilio Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558497909 PECOS PAC ID: 8527472356 Enrollment ID: I20210205001393 |
| Provider Name | Terrance Eugene Poindexter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225441751 PECOS PAC ID: 9133538135 Enrollment ID: I20210504000508 |
| Provider Name | Audrey Anna Katz |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1366012536 PECOS PAC ID: 8527461490 Enrollment ID: I20210729002464 |
| Provider Name | Sheryl B Carney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437297306 PECOS PAC ID: 7416349816 Enrollment ID: I20220114001841 |
| Provider Name | Peter Mugetha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861110991 PECOS PAC ID: 8820464530 Enrollment ID: I20221021000282 |
| Provider Name | Bhawna Jha |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1154536886 PECOS PAC ID: 6901064765 Enrollment ID: I20231102000661 |
Heart City Health Center Pharmacy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 236 Simpson Ave, Elkhart, IN 46516 Phone: 574-970-1441 Fax: 574-970-1449 | |
Elkhart Clinic, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 303 S Nappanee St, Elkhart, IN 46514 Phone: 574-296-3200 Fax: 574-296-3392 | |
Elkhart Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2117 W Lexington Ave, Elkhart, IN 46514 Phone: 574-296-3444 Fax: 574-296-3328 | |
Elkhart Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2222 W Lexington Ave, Suite B, Elkhart, IN 46514 Phone: 574-296-3200 Fax: 574-296-3392 | |
Activate Healthcare - Waste Away Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1621 W Beardsley Ave, Elkhart, IN 46514 Phone: 773-697-3144 | |
Beacon Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1506 Osolo Rd Ste C, Elkhart, IN 46514 Phone: 574-266-6050 Fax: 574-262-8485 | |
Susan M Moore-riesbeck Do Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 28070 County Road 24, Elkhart, IN 46517 Phone: 574-273-8053 Fax: 574-273-8056 |