Individual provider Active NPI

Thomas Edmund Kreider, MD

  • Psychiatry Physician
  • Goshen, IN
National Provider Identifier
1093770547
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01051361 Issued in IN
Practice address
213 Middlebury St
Goshen, IN 46528-2956
Phone
(574) 534-3300
Fax
(574) 534-5412
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01051361 IN Primary

Addresses

Primary practice location

213 Middlebury St
Goshen, IN 46528-2956

Mailing address

213 Middlebury St
Goshen, IN 46528-2956
Phone (574) 534-0088

Other practice location 1

808 N 3rd St
Goshen, IN 46528-7100
Phone (574) 534-0088

Other identifiers 1

IdentifierTypeStateIssuer
200249480AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tkreider299548@direct.ochin.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01051361INMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maple City Health Care Center, Inc. Current Accepting new patients
Behavioral Healthcare Consultants, P.C. Past Accepting new patients
Major Hospital Past Accepting new patients
Community Health Network, Inc. Past Accepting new patients
Community Health Network, Inc Past Accepting new patients

Locations

213 Middlebury St
Goshen, IN 46528
Phone (574) 534-0088

808 N 3rd St
Goshen, IN 46528
Phone (574) 534-0088

Interoperability endpoints

  • Direct secure messaging: tkreider299548@direct.ochin.org

Organizations & group practices 5

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": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1093770547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-0088",
            "fax_number": "574-534-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-3300",
            "fax_number": "574-534-5412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "808 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465287100",
            "country_code": "US",
            "telephone_number": "574-534-0088",
            "fax_number": "574-971-8434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KREIDER",
        "first_name": "THOMAS",
        "middle_name": "EDMUND",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01051361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200249480A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tkreider299548@direct.ochin.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "213 Middlebury St",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465282956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; 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.