MEDICARE: BLUE GEMS ABA IN LLC

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992473409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE GEMS ABA IN LLC

Provider Business Mailing Address
First Line	:	201 N ILLINOIS ST FL 16
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1904
Country	:	US
Telephone Number	:	617-297-7998
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N ILLINOIS ST FL 16
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1904
Country	:	US
Telephone Number	:	317-300-7695
Fax Number	:	617-340-3371

Authorized Official
Title or Position	:	CEO
Name	:	DAVID WOLF
Credential	:
Telephone Number	:	617-297-7998

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	06/01/2026

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