Individual provider Active NPI

Vijay G.T. Kamineni, M.D.

  • Internal Medicine Physician
  • Lagrange, IN
National Provider Identifier
1043278294
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01061449A Issued in IN
Practice address
2500 N Detroit St
Lagrange, IN 46761-1158
Phone
(260) 463-2133
Fax
(260) 463-3775
NPI assigned
May 3, 2006
Last updated
Apr 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01061449A IN Primary

Addresses

Primary practice location

2500 N Detroit St
Lagrange, IN 46761-1158

Mailing address

PO Box 236
Lagrange, IN 46761-0236
Phone (260) 463-2133

Other practice location 1

610 N Sawyer Rd
Kendallville, IN 46755-2566
Phone (260) 347-5592

Other practice location 2

2200 Randallia Dr
Fort Wayne, IN 46805-4638
Phone (260) 266-2020

Other identifiers 1

IdentifierTypeStateIssuer
200821610MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060405000163 IN Practitioner - Internal Medicine 9133137961 Reassigns benefits to 1 organization
I20240914000090 OH Practitioner - Internal Medicine 9133137961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Internal Medicine Associates, PCGroup PAC ID 7113830688, 52 clinicians

Practice addresses (Care Compare)

2500 N Detroit St
Lagrange, IN 46761-1158
Phone (260) 463-2133

433 W High St
Bryan, OH 43506-1690
Phone 2604632133111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.02 of 100Reported as group
Quality
74.88
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

Merit-based Incentive Payment System (MIPS)

Final score
91.92 of 100Reported as group
Quality
81.41
Promoting interoperability
100
Improvement activities
40
Cost
78.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01061449AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Internal Medicine Associates, PC Internal Medicine CurrentSince Jul 10, 2006 Accepting new patients
Northeast Internal Medicine Associates, PC Current Accepting new patients

Locations

610 N Sawyer Rd
Kendallville, IN 46755
Phone (260) 347-5592

2500 N Detroit St
Lagrange, IN 46761
Phone (260) 463-2133

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

909 E Snyder Ave
Montpelier, OH 43543
Phone (419) 485-3154

1250 S Washington St
Van Wert, OH 45891
Phone (419) 232-2077

Interoperability endpoints

  • Direct secure messaging: vkamineni5310@direct.parkviewexchange.com

Organizations & group practices 2

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 7

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1043278294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 236",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467610236",
            "telephone_number": "260-463-2133",
            "fax_number": "260-463-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N DETROIT ST",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467611158",
            "telephone_number": "260-463-2133",
            "fax_number": "260-463-3775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 N Sawyer Rd",
            "address_purpose": "LOCATION",
            "city": "Kendallville",
            "state": "IN",
            "postal_code": "467552566",
            "country_code": "US",
            "telephone_number": "260-347-5592",
            "fax_number": "260-347-5155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 Randallia Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468054638",
            "country_code": "US",
            "telephone_number": "260-266-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAMINENI",
        "first_name": "VIJAY",
        "middle_name": "G.T.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01061449A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200821610",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, IN

Sources for this page

Verify at the official NPI Registry.