NPIMap

Organization Active NPI

Bloomington Kidney & Hypertension Specialists PC

  • Nephrology Physician
  • Bloomington, IN
National Provider Identifier
1164536587
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
BLOOMINGTON KIDNEY & HYPERTENSION SPECIALISTS PC
Practice address
515 S Woodscrest Dr
Bloomington, IN 47401
Phone
(812) 333-8194
Fax
(812) 333-8237
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Authorized official

Name
Hideki Kawanishi, MDNPI 1376657783
Title
President
Phone
(812) 333-8194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

515 S Woodscrest Dr
Bloomington, IN 47401

Mailing address

PO Box 6715
Bloomington, IN 47407-6715
Phone (812) 333-8194

Other identifiers 1

IdentifierTypeStateIssuer
200498840AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050602000959 IN Part B Supplier - Clinic/Group Practice 3173566999 Receives reassigned benefits from 2 practitioners
Practice locations: Bloomington, IN; Spencer, IN; Paoli, IN; Linton, IN; Bedford, IN

National Provider Directory

National Provider Directory

Locations

3253 Shawnee Dr S
Ste C
Bedford, IN 47421
Phone (812) 275-1084

1204 N 1000 W
Linton, IN 47441
Phone (812) 232-8716

555 W Longest St
Paoli, IN 47454
Phone (812) 723-3571

Practitioners & affiliated clinicians

Practitioners 3

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": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1164536587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6715",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474076715",
            "telephone_number": "812-333-8194",
            "fax_number": "812-333-8237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S WOODSCREST DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47401",
            "telephone_number": "812-333-8194",
            "fax_number": "812-333-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON KIDNEY & HYPERTENSION SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "KAWANISHI",
        "authorized_official_first_name": "HIDEKI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-333-8194",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200498840A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.