Active NPI
Kathleen Wallace, APN
- Nurse Practitioner
- Merrillville, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71000826A
- Practice address
- 90 W 86TH Ave
Merrillville, IN 46410-7086 - Phone
- (219) 791-1555
- Fax
- (219) 791-1560
- NPI assigned
- Jul 1, 2005
- Last updated
- Dec 13, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71000826A | IN | Primary |
Addresses
Primary practice location
90 W 86TH Ave
Merrillville, IN 46410-7086
Mailing address
120 W 22ND St Ste 200
Oak Brook, IL 60523-1563
Phone (630) 573-5000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | credentialing@nephdocs.com | Direct |
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
90 W 86TH Ave
Nephrology Associates of Northern Indiana P
Merrillville, IN 46410-7086
Phone (219) 791-1555
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nephrology Associates of Northern Indiana, Inc | Current | Accepting new patients |
Locations
120 W 22nd St
Ste 200
Oak Brook, IL 60523
Phone (630) 575-5000
855 Madison St
Oak Park, IL 60302
Phone (708) 386-1000
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
Interoperability endpoints
- credentialing@nephdocs.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- kwallace41389@direct.acumenmd.com
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.
-
- Nephrology Physician
- Fort Wayne, IN
- NPI 1578505814
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Powers Health Rehabilitation Center
- Rehabilitation Hospital
- Crown Point, IN
- NPI 1801301437
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Crown Point, IN
- NPI 1336205798
-
- General Acute Care Hospital
- Munster, IN
- NPI 1427493246
-
dba Community Hospital
- General Acute Care Hospital
- Munster, IN
- NPI 1003918210
-
- General Acute Care Hospital
- East Chicago, IN
- NPI 1689776882
-
- General Acute Care Hospital
- Hobart, IN
- NPI 1558463745
-
dba St Mary Wound Clinic
- General Acute Care Hospital
- Hobart, IN
- NPI 1962504175
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670889600000",
"number": "1225035504",
"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",
"fax_number": "630-491-5472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 W 86TH AVE",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464107086",
"telephone_number": "219-791-1555",
"fax_number": "219-791-1560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KATHLEEN",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-01",
"last_updated": "2022-12-13",
"certification_date": "2022-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71000826A",
"primary": true
}
],
"identifiers": [],
"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 Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.