NPIMap

Individual provider Active NPI

Clinton L. Kauffman, MD

  • Family Medicine Physician
  • Winamac, IN
National Provider Identifier
1013062686
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01057944A Issued in IN
Practice address
540 Hospital Dr
Winamac, IN 46996
Phone
(574) 946-2194
Fax
(574) 946-2196
NPI assigned
Jan 24, 2007
Last updated
Mar 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01057944A IN Primary

Addresses

Primary practice location

540 Hospital Dr
Winamac, IN 46996

Mailing address

540 Hospital Dr
Winamac, IN 46996-1173
Phone (574) 946-2194

Other identifiers 2

IdentifierTypeStateIssuer
01057944AOtherINSTATE LICENSE
200444820MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070828000370 IN Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 8325017957 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology
Education
Virginia Commonwealth University, School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pulaski Memorial HospitalGroup PAC ID 3173515509, shared by 32 NPIs, 45 clinicians

Practice addresses (Care Compare)

540 Hospital Dr
Winamac, IN 46996-1173
Phone (574) 946-2194

616 E 13TH St
Winamac, IN 46996-1117
Phone (574) 946-2100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01057944AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pulaski Memorial Hospital CurrentSince Aug 11, 2003 Accepting new patients
Pulaski Memorial Hospital Current Accepting new patients
Pulaski Memorial Hospital CurrentSince Aug 11, 2003 Accepting new patients
Major Hospital Past Accepting new patients
Pulaski Memorial Hospital Past Accepting new patients
Family & Women's Health Services Family Medicine PastSince Dec 14, 2011 Accepting new patients

Locations

540 Hospital Dr
Winamac, IN 46996
Phone (574) 935-4327

616 E 13th St
Winamac, IN 46996
Phone (574) 946-2100

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/pulaski-0086e204

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pulaski Memorial HospitalWinamac, IN, CCN 151305 Hospital Corporate Director (14.29%) Aug 1, 2019
Pulaski Memorial HospitalWinamac, IN, CCN 15Z305 Hospital Corporate Director (14.29%) Aug 1, 2019
Pulaski Health Care CenterWinamac, IN, CCN 155660 Skilled nursing facility Corporate Director Aug 1, 2019
Parkview HavenFrancesville, IN, CCN 155746 Skilled nursing facility Corporate Officer (14.29%)
Corporate Director (14.29%)		 Aug 1, 2019
Aug 1, 2019
Kingston Health Center of Fort WayneFort Wayne, IN, CCN 155479 Skilled nursing facility Trustee of the SNF Dec 16, 2025
Briarcliff Health & Rehabilitation CenterSouth Bend, IN, CCN 155831 Skilled nursing facility Corporate Director (100%) Jan 1, 2024
South Shore Health & Rehabilitation CenterGary, IN, CCN 155530 Skilled nursing facility Corporate Director (100%) Jan 1, 2024
Asbury Towers Health Care CenterGreencastle, IN, CCN 155758 Skilled nursing facility Managing Control - Governing Body Jul 1, 2024
Healthwin Health & RehabilitationSouth Bend, IN, CCN 155153 Skilled nursing facility Trustee of the SNF Jan 8, 2025
Pulaski Memorial HospitalWinamac, IN, CCN 158512 Rural health clinic Corporate Director (14.29%) Aug 1, 2019
Pulaski Memorial Hospital Francesville Family MedicineFrancesville, IN, CCN 158528 Rural health clinic Corporate Director Aug 1, 2019
Pulaski Memorial Hospital North Judson Family MedicineNorth Judson, IN, CCN 158527 Rural health clinic Corporate Director Aug 1, 2019
Pulaski Memorial Hospital Knox Medical CenterKnox, IN, CCN 158554 Rural health clinic Corporate Director Aug 1, 2019
Pulaski Memorial Hospital Culver Medical CenterCulver, IN, CCN 158581 Rural health clinic Corporate Director Aug 1, 2019

Owned or controlled facilities with NPI records 14

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 14

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1013062686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 HOSPITAL DR",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "469961173",
            "telephone_number": "574-946-2194",
            "fax_number": "574-946-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 HOSPITAL DR",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "46996",
            "telephone_number": "574-946-2194",
            "fax_number": "574-946-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFFMAN",
        "first_name": "CLINTON",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01057944A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "01057944A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200444820",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winamac, IN

Sources for this page

Verify at the official NPI Registry.