NPIMap

Organization Active NPI

Willow Creek Medical LLC

  • Internal Medicine Physician
  • Portage, IN
National Provider Identifier
1073660049
Registry record updated Dec 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
010133934B Issued in IN
Legal business name
WILLOW CREEK MEDICAL LLC
Practice address
3156 Willowcreek Rd
Portage, IN 46368-4424
Phone
(219) 762-4999
Fax
(219) 762-2288
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2010

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

Authorized official

Name
Dr. Ashwani Kumar, M.D.
Title
President
Phone
(219) 762-4999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 010133934B IN Primary

Addresses

Primary practice location

3156 Willowcreek Rd
Portage, IN 46368-4424

Mailing address

3156 Willowcreek Rd
Portage, IN 46368-4424
Phone (219) 762-4999

Other identifiers 2

IdentifierTypeStateIssuer
200237500MedicaidIN
CG2594OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292544000000",
    "number": "1073660049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684424",
            "telephone_number": "219-762-4999",
            "fax_number": "219-762-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684424",
            "telephone_number": "219-762-4999",
            "fax_number": "219-762-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2010-12-17",
        "status": "A",
        "authorized_official_last_name": "KUMAR",
        "authorized_official_first_name": "ASHWANI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-762-4999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "010133934B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200237500",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG2594",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.