Individual provider Active NPI

Henry Kirori

  • Family Nurse Practitioner
  • Elkhart, IN
National Provider Identifier
1225816739
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71014664A Issued in IN
Practice address
500 Arcade Ave Ste 400
Elkhart, IN 46514-2487
Phone
(574) 522-2284
NPI assigned
Sep 18, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71014664A IN Primary

Addresses

Primary practice location

500 Arcade Ave Ste 400
Elkhart, IN 46514-2487

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
300084816MedicaidIN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231226001284 IN Practitioner - Nurse Practitioner 3971953480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

500 Arcade Ave
Suite 210
Elkhart, IN 46514-2485
Phone (574) 389-5656

Hospital & facility affiliations

  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71014664AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Family CurrentSince Dec 31, 2023 Accepting new patients
Beacon Medical Group Inc CurrentSince Dec 31, 2023 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

500 Arcade Ave
Ste 400
Elkhart, IN 46514
Phone (574) 522-2284

500 Arcade Ave
Ste 210
Elkhart, IN 46514
Phone (574) 389-5656

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1225816739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 400",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142487",
            "telephone_number": "574-522-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRORI",
        "first_name": "HENRY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-18",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71014664A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300084816",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.