NPIMap

Individual provider Active NPI

Christiane Nwawock Mbianda, M.D.

  • Nephrology Physician
  • Mishawaka, IN
National Provider Identifier
1255656138
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01075238A Issued in IN
Practice address
710 Park PL
Mishawaka, IN 46545-3519
Phone
(574) 273-6787
Fax
(574) 968-7160
NPI assigned
Apr 2, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X WI
Internal Medicine Physician 207R00000X 01075238A IN
Nephrology Physician 207RN0300X 01075238A IN Primary

Addresses

Primary practice location

710 Park PL
Mishawaka, IN 46545-3519

Mailing address

PO Box 5909
Portland, OR 97228-5909
Phone (574) 273-6767

Other identifiers 1

IdentifierTypeStateIssuer
201291860MedicaidIN

Other names 1

  • Christiane Nwawock Ngonga Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150612002065 IN Practitioner - NephrologyPractitioner - Internal Medicine 3870804123 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Medical College of Wisconsin, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology Physicians, LLCGroup PAC ID 1850289273, 11 clinicians

Practice addresses (Care Compare)

710 Park PL
Mishawaka, IN 46545-3519
Phone (574) 273-6767

Hospital & facility affiliations

  • FMC - Nephrology - Home Dialysis facility, Mishawaka, IN, CCN 152612
  • Fresenius Kidney Care North Elkhart Dialysis facility, Elkhart, IN, CCN 152703
  • FMC - Nephrology - Marshall County Dialysis facility, Plymouth, IN, CCN 152611
  • DaVita Irish at Home Dialysis facility, South Bend, IN, CCN 152668
  • DaVita Elkhart Dialysis Dialysis facility, Elkhart, IN, CCN 152664
  • Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076
  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Woodlawn Hospital Hospital, Rochester, IN, CCN 151313

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Apr 9, 2019 Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Apr 9, 2019 Accepting new patients
Hospitalist Medicine Physicians of Indiana, LLC Internal Medicine CurrentSince Apr 14, 2019 Accepting new patients

Locations

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

Interoperability endpoints

  • Direct secure messaging: cmbianda17501@direct.acumenmd.com

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 12

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": "1270166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1255656138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5909",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972285909",
            "telephone_number": "574-273-6767",
            "fax_number": "749-687-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 PARK PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453519",
            "telephone_number": "574-273-6787",
            "fax_number": "574-968-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBIANDA",
        "first_name": "CHRISTIANE",
        "middle_name": "NWAWOCK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01075238A",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01075238A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201291860",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTIANE",
            "last_name": "NGONGA",
            "middle_name": "NWAWOCK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.