NPIMap

Organization Active NPI

Kidney Care of Michiana LLC

  • Nephrology Physician
  • Mishawaka, IN
National Provider Identifier
1093067530
Registry record updated Oct 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
KIDNEY CARE OF MICHIANA LLC
Practice address
3665 Park PL W
Suite 300
Mishawaka, IN 46545-3566
Phone
(574) 607-4724
NPI assigned
Oct 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2012

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

Authorized official

Name
Leslie Ann Schmit
Title
Partner
Phone
(574) 607-4724

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

3665 Park PL W
Suite 300
Mishawaka, IN 46545-3566

Mailing address

3665 Park PL W
Suite 300
Mishawaka, IN 46545-3566
Phone (574) 607-4724

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121207000347 IN Part B Supplier - Clinic/Group Practice 7810149309 Receives reassigned benefits from 10 practitioners
Practice locations: Elkhart, IN; Mishawaka, IN

National Provider Directory

National Provider Directory

Locations

2222 W Lexington Ave
Elkhart, IN 46514
Phone (219) 294-3030

515 Park Place Cir
Ste 200
Mishawaka, IN 46545
Phone (574) 607-4724

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5893/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1093067530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3665 PARK PL W",
            "address_2": "SUITE 300",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453566",
            "telephone_number": "574-607-4724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3665 PARK PL W",
            "address_2": "SUITE 300",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453566",
            "telephone_number": "574-607-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CARE OF MICHIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "SCHMIT",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "574-607-4724"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; 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.