| Ltc Aco | |
|
9894 E 121st St Fishers IN 46037-4154 | |
| (317) 621-6060 | |
| (317) 355-6965 |
| Full Name | Ltc Aco |
|---|---|
| Speciality | Family Medicine |
| Location | 9894 E 121st St, Fishers, Indiana |
| Authorized Official Name and Position | John Kunzer (EVP) |
| Authorized Official Contact | 3173557171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ltc Aco 9894 E 121st St Fishers IN 46037-4154 Ph: (317) 621-6060 | Ltc Aco 9894 E 121st St Fishers IN 46037-4154 Ph: (317) 621-6060 |
| NPI Number | 1366123176 |
|---|---|
| Provider Enumeration Date | 07/26/2023 |
| Last Update Date | 09/14/2026 |
| Certification Date | 09/14/2026 |
| Medicare PECOS PAC ID | 3476084120 |
|---|---|
| Medicare Enrollment ID | O20241004001710 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366123176 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Primary |
| Provider Name | Mahmoud Yassin Kassab |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144281486 PECOS PAC ID: 6103858774 Enrollment ID: I20050902000532 |
| Provider Name | Abdulateef O Aregbe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972756245 PECOS PAC ID: 1254482763 Enrollment ID: I20090623000685 |
| Provider Name | Tammy N Durham-boring |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1023098639 PECOS PAC ID: 3779764592 Enrollment ID: I20110225000580 |
| Provider Name | Brandi Leigh Ann Wash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811263940 PECOS PAC ID: 2961664073 Enrollment ID: I20120508000218 |
| Provider Name | George Hoyek |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1255521092 PECOS PAC ID: 9638348543 Enrollment ID: I20160718000565 |
| Provider Name | Masita Poray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386197770 PECOS PAC ID: 9931480225 Enrollment ID: I20161228001245 |
| Provider Name | Ahmad Mossa-basha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306263306 PECOS PAC ID: 8921317322 Enrollment ID: I20170727002505 |
| Provider Name | Bobbie Nakole Jellison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023336443 PECOS PAC ID: 1557594264 Enrollment ID: I20180406000585 |
| Provider Name | Tiffini Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093209348 PECOS PAC ID: 1850640400 Enrollment ID: I20180815002773 |
| Provider Name | Mohammad Sami Bakdash |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104271790 PECOS PAC ID: 8628361037 Enrollment ID: I20190715000718 |
| Provider Name | Svetlana Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093366478 PECOS PAC ID: 4385073469 Enrollment ID: I20200413000691 |
| Provider Name | Ramon Eduardo Santos Olivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053867309 PECOS PAC ID: 3870889009 Enrollment ID: I20200915001203 |
| Provider Name | Josephine Mwachande |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073184206 PECOS PAC ID: 0143618645 Enrollment ID: I20211103000906 |
| Provider Name | Jessica Julie Pietras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417627563 PECOS PAC ID: 9335510445 Enrollment ID: I20230128000283 |
| Provider Name | Allison Marie Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861248247 PECOS PAC ID: 5799227757 Enrollment ID: I20240605001572 |
| Provider Name | Dannah Kim Saldua Dumdum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588455265 PECOS PAC ID: 6204341753 Enrollment ID: I20250714002640 |
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