MEDICARE: GERIATRIC PRIMARY CARE OF INDIANA 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1992506588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC PRIMARY CARE OF INDIANA LLC

Provider Business Mailing Address
First Line	:	12120 STATE LINE RD # 296
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209-1254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5354 W 62ND ST APT 176C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6436
Country	:	US
Telephone Number	:	850-377-0925
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARK BATTIST
Credential	:
Telephone Number	:	850-377-0925

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	12/08/2025

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