Supro Direct - Medicare Primary Care in Greenwood, IN

Supro Direct is a medicare enrolled primary clinic (Family Medicine) in Greenwood, Indiana. The current practice location for Supro Direct is 701 E County Line Rd, Suite 210, Greenwood, Indiana. For appointments, you can reach them via phone at (317) 300-7424. The mailing address for Supro Direct is 701 E County Line Rd, Suite 210, Greenwood, Indiana and phone number is (317) 300-7424.

Supro Direct is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1750829230. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (317) 300-7424.

Contact Information

Supro Direct
701 E County Line Rd
Suite 210
Greenwood
IN 46143-1072
(317) 300-7424
(317) 360-7976

Primary Care Clinic Profile

Full NameSupro Direct
SpecialityFamily Medicine
Location701 E County Line Rd, Greenwood, Indiana
Authorized Official Name and PositionPraveen Rajanahalli (TIN OWNER)
Authorized Official Contact3173007424
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Supro Direct
701 E County Line Rd
Suite 210
Greenwood
IN 46143-1072

Ph: (317) 300-7424
Supro Direct
701 E County Line Rd
Suite 210
Greenwood
IN 46143-1072

Ph: (317) 300-7424

NPI Details:

NPI Number1750829230
Provider Enumeration Date02/06/2017
Last Update Date10/09/2023

Medicare PECOS Information:

Medicare PECOS PAC ID8921383605
Medicare Enrollment IDO20170320001957

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Medical Identifiers

Medical identifiers for Supro Direct such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1750829230NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine (* (Not Available))Primary
2084P0800XPsychiatry & Neurology - Psychiatry (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Supro Direct acts as a billing entity for following providers:
Provider NamePraveen Rajanahalli
Provider TypePractitioner - General Practice
Provider IdentifiersNPI Number: 1497925572
PECOS PAC ID: 2365636669
Enrollment ID: I20101101000480

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