Individual provider Active NPI

Kumar Venkatachalam, MD

  • Gastroenterology Physician
  • Merrillville, IN
National Provider Identifier
1154325421
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01048257A Issued in IN
Practice address
8895 Broadway
Merrillville, IN 46410-7037
Phone
(219) 738-2081
Fax
(219) 736-4658
NPI assigned
Jun 2, 2005
Last updated
May 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01048257A IN Primary

Addresses

Primary practice location

8895 Broadway
Merrillville, IN 46410-7037

Mailing address

8558 Broadway
Merrillville, IN 46410-7032
Phone (219) 392-7084

Other practice location 1

10215 Broadway Ste 203
Crown Point, IN 46307-8001
Phone (219) 947-6795

Other identifiers 4

IdentifierTypeStateIssuer
200180870AMedicaidIN
110168975OtherINRAILROAD MEDICARE
9115389OtherILANTHEM BC/BS
000000085025OtherINANTHEM BC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20070813000230 IN Practitioner - GastroenterologyPractitioner - Internal Medicine 4082612007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

10215 Broadway
Suite 203
Crown Point, IN 46307-8001
Phone (219) 661-6148

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy217
Upper gastrointestinal (GI) endoscopy for acid reflux201

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc CurrentSince Jul 1, 2020 Accepting new patients

Locations

8558 Broadway
Merrillville, IN 46410
Phone (219) 392-7084

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

Interoperability endpoints

  • Direct secure messaging: kvenkat11455@ssdirect.comhs.org

Organizations & group practices 1

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 6

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": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1154325421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8558 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107032",
            "telephone_number": "219-392-7084",
            "fax_number": "219-703-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8895 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107037",
            "telephone_number": "219-738-2081",
            "fax_number": "219-736-4658"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10215 Broadway Ste 203",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463078001",
            "country_code": "US",
            "telephone_number": "219-947-6795",
            "fax_number": "219-703-6830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VENKATACHALAM",
        "first_name": "KUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-02",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01048257A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200180870A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110168975",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "9115389",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000085025",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.