NPIMap

Individual provider Active NPI

Kanakapura Venkatakrishna, MD

  • Nephrology Physician
  • Fort Wayne, IN
National Provider Identifier
1144222142
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01045053A Issued in IN
Practice address
11104 Parkview Circle Dr
Entrance 11, Suite 330
Fort Wayne, IN 46845-1730
Phone
(260) 494-3484
Fax
(260) 969-0188
NPI assigned
Aug 10, 2005
Last updated
Nov 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 35.067919 OH
Nephrology Physician 207RN0300X 01045053A IN Primary

Addresses

Primary practice location

11104 Parkview Circle Dr
Entrance 11, Suite 330
Fort Wayne, IN 46845-1730

Mailing address

120 W 22ND St Ste 200
Oak Brook, IL 60523-1563
Phone (630) 573-5000

Other identifiers 4

IdentifierTypeStateIssuer
200093260MedicaidIN
100082060MedicaidIN
000000095598OtherINBCBS
0310587MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@nephdocs.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101030000157 IN Practitioner - Nephrology 2860584679 Reassigns benefits to 1 organization
I20120113000609 OH Practitioner - Nephrology 2860584679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates of Northern Indiana PCGroup PAC ID 8921033440, 64 clinicians

Practice addresses (Care Compare)

11104 Parkview Circle Dr
Suite 330
Fort Wayne, IN 46845-1674
Phone (260) 494-3484

1833 Magnavox Way
Suite 100
Fort Wayne, IN 46804-1539
Phone (260) 918-0997

208 Columbus St N
Hicksville, OH 43526-1250
Phone (630) 573-5000

3334 Lake City Hwy
Warsaw, IN 46580-3923
Phone (574) 269-3553

569 Tyler St
Gary, IN 46402-1829
Phone (260) 885-3300

7836 W Jefferson Blvd
101 Nephrology Associates of Northern India
Fort Wayne, IN 46804-4178
Phone (260) 494-3484

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.067919OHMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Northern Indiana, Inc Nephrology CurrentSince Oct 1, 1994 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Indiana Nephrology and Internal Medicine, P.C. Nephrology Past Accepting new patients

Locations

120 W 22nd St
Ste 200
Oak Brook, IL 60523
Phone (630) 575-5000

11104 Parkview Circle Dr
Ste 330
Fort Wayne, IN 46845
Phone (888) 543-6397

569 Tyler St
Gary, IN 46402
Phone (260) 885-3300

90 W 86th Ave
Merrillville, IN 46410
Phone (219) 791-1555

208 Columbus St
Hicksville, OH 43526
Phone (419) 542-6692

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kvenkatakrishna42471@direct.acumenmd.com

Organizations & group practices 3

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 10

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1144222142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 22ND ST STE 200",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231563",
            "telephone_number": "630-573-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11104 PARKVIEW CIRCLE DR",
            "address_2": "ENTRANCE 11, SUITE 330",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451730",
            "telephone_number": "260-494-3484",
            "fax_number": "260-969-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATAKRISHNA",
        "first_name": "KANAKAPURA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OH",
            "license": "35.067919",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01045053A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200093260",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100082060",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000095598",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0310587",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@nephdocs.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "120 W 22nd St Ste 200",
            "city": "Oak Brook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605231563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.