MEDICARE: SIMPLICITY HEALTH INDIANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1699561779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLICITY HEALTH INDIANA

Provider Business Mailing Address
First Line	:	110 E MARKET ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3410
Country	:	US
Telephone Number	:	502-200-7043
Fax Number	:	502-273-1502

Provider Business Practice Location Address
First Line	:	110 E MARKET ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3410
Country	:	US
Telephone Number	:	502-445-7957
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	RAUL THOMAS
Credential	:
Telephone Number	:	502-208-4070

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	12/08/2025

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Directions to “SIMPLICITY HEALTH INDIANA ” Practice Location

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