Individual provider Active NPI

Kyley Struck

  • Certified Registered Nurse Anesthetist
  • Indianapolis, IN
National Provider Identifier
1003545831
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28230241A Issued in IN
Practice address
7150 Clearvista Dr
Indianapolis, IN 46256-1695
Phone
(317) 621-5890
NPI assigned
Jun 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 28230241A IN Primary

Addresses

Primary practice location

7150 Clearvista Dr
Indianapolis, IN 46256-1695

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890
Phone (317) 621-7547

Other practice location 1

615 N Michigan St
South Bend, IN 46601-1087
Phone (574) 647-1000

Other practice location 2

1400 E 9th St
Rochester, IN 46975-8931
Phone (574) 223-3141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220615001831 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608255039 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
28230241AINMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ams Northern Indiana LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2024 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Jul 22, 2024 Accepting new patients
Great Lakes Anesthesia, P.C. Nurse Anesthetist, Certified Registered CurrentSince Dec 11, 2023 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Jul 22, 2024 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Past Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

1004 Parkway Ave
Ste A
Elkhart, IN 46516
Phone (800) 966-7841

7150 Clearvista Dr
Indianapolis, IN 46256
Phone (317) 355-5041

8111 S Emerson Ave
Indianapolis, IN 46237
Phone (317) 528-5261

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

1400 E 9th St
Rochester, IN 46975
Phone (574) 223-2020

Interoperability endpoints

  • Direct secure messaging: kstruck618430@ecommunitydirect.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1003545831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890",
            "telephone_number": "317-621-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 CLEARVISTA DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561695",
            "telephone_number": "317-621-5890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 N Michigan St",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011087",
            "country_code": "US",
            "telephone_number": "574-647-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 E 9th St",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "IN",
            "postal_code": "469758931",
            "country_code": "US",
            "telephone_number": "574-223-3141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STRUCK",
        "first_name": "KYLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28230241A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.