PROACTIVE MSO, LLC
NPI 1174076145
Clinic/Center - Primary Care in Brazil, IN
NPI Status: Active since July 26, 2016
Contact Information
501 E JACKSON ST
BRAZIL, IN
ZIP 47834
Phone: (812) 420-1410
Fax: (812) 420-1488
- Organization
- Clinic/Center
- Primary Care
- CLIA Number: 15D2065624
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 09-11-2025
About PROACTIVE MSO, LLC
This page provides the complete NPI Profile along with additional information for Proactive Mso, Llc, a primary care provider established in Brazil, Indiana operating as a Clinic/center, focusing in primary care . The healthcare provider is registered in the NPI registry with number 1174076145 assigned on July 2016. The practitioner's primary taxonomy code is 261QP2300X with license number 01059956A (IN). The provider is registered as an organization and their NPI record was last updated April 2025. The provider's
- NPI
- 1174076145
- Provider Legal Name
- PROACTIVE MSO, LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 501 E JACKSON ST BRAZIL, IN 47834
- Location Phone
- (812) 420-1410
- Location Fax
- (812) 420-1488
- Mailing Address
- 124 ALLAWOOD CT SIMPSONVILLE, SC 29681
- Mailing Phone
- (864) 501-0751
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-26-2016
- Last Update Date
- 04-03-2025
- Code Navigator
A primary care provider (PCP) like Proactive Mso, Llc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Primary Care
- Taxonomy Code
- 261QP2300X
- Type
- Ambulatory Health Care Facilities
- License No.
- 01059956A
- License State
- IN
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 15D2065624
- Facility Type
- Practitioner Other
- Certificate Effective Date
- September 12, 2023
- Certificate Expiration Date
- September 11, 2025
- Laboratory Director
- JANICE HIGGINS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Proactive Mso, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 7 | 4 | 0 | 7 | 6 | 1 | 4 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 14 | 4 | 0 | 7 | 12 | 1 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 4 + 4 + 0 + 7 + 1 + 2 + 1 + 8 + 24 = 55 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 55 = 5 | 5 | ||||||||
The NPI number 1174076145 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1013628809 | HEATHER RENEE GIBBENS FNP-C Individual | Nurse Practitioner (Primary Care) | 501 E JACKSON ST BRAZIL, IN 47834 (812) 264-2765 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174076145, enumerated in the NPI registry as an "organization" on July 26, 2016
The provider is located at 501 E Jackson St Brazil, In 47834 and the phone number is (812) 420-1410
This medical organization specializes in Clinic/Center with taxonomy code 261QP2300X with a focus in Primary Care
The provider's CLIA number is 15D2065624 for a "practitioner other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on July 26, 2016. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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