Kurtis Dejong, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

01039621 Issued in IN

Practice address

5215 Holy Cross Pkwy
Emergency Department
Mishawaka, IN 46545-1469

Phone

(574) 335-5000

NPI assigned

Apr 26, 2006

Last updated

Dec 16, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

Specialty

Emergency MedicineAlso: Internal Medicine

Education

University of Iowa, RJ & L Carver College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076
• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdejong1158698@direct.trinity-health.org

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.

• Cep America LLC

  • Emergency Medicine Physician
  • Terre Haute, IN
  • NPI 1285103671
  Medicare reassignment Care Compare group NPD
• Elite Emergency Physicians Inc

  • Emergency Medicine Physician
  • Elkhart, IN
  • NPI 1932155371
  Medicare reassignment NPD
• Valley Emergency Physicians Inc

  • Emergency Medicine Physician
  • Mishawaka, IN
  • NPI 1154377794
  NPD (past) Authorized official
• Cep America LLC

  • Emergency Medicine Physician
  • Mishawaka, IN
  • NPI 1811796006
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD
• Elite Emergency Physicians Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Goshen, IN
  • NPI 1275646283
  NPD (past)
• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  dba Saint Joseph Foot and Ankle Sports Medicine Institute Plymouth

  • Family Medicine Physician
  • Plymouth, IN
  • NPI 1538585187
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  • General Acute Care Hospital
  • Plymouth, IN
  • NPI 1174571129
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1184680159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-335-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-335-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "KURTIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01039621",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IN",
            "license": "01039621",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000190295",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104943838",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200022520",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "930102831",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Kriegel LLC
• Laura Decastor, MD
• John M Decelles, M.D.
• Lindsey A. Decicco, PTA
• Keandra Denise Dejohnette
• Del Pilar Medical & Urgent Care PC
• Arnold Del Pilar Jr., D.O.
• Kimberly D Delcourt, MSW, LCSW
• Kacy Denesuk, LCSW
• Denise Strzelecki LMHC LLC

• Emergency Medicine Physician in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.