Walter Douglas Kolmodin, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

07000902A Issued in IN

Practice address

14950 State Road 23
Granger, IN 46530-7564

Phone

(574) 259-9668

Fax

(574) 259-9671

NPI assigned

Sep 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

College of Podiatric Med and Surgery, Des Moines University, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
• Unity Physicians Hospital Hospital, Mishawaka, IN, CCN 150177

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wkolmodin256576@dulyhealthandcare.direct-ci.com
• Direct secure messaging: wkolmodin1161460@direct.trinity-health.org
• FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

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.

• The South Bend Clinic LLC

  • Clinic/Center
  • South Bend, IN
  • NPI 1073680419
  Medicare reassignment Care Compare group NPD
• The South Bend Clinic, LLC

  • Anesthesiology Physician
  • South Bend, IN
  • NPI 1487307492
  NPD
• Northern Indiana Foot & Ankle Assoc Inc

  • Podiatric Clinic/Center
  • Plymouth, IN
  • NPI 1659366029

  Podiatrist

  NPD (past)
• Yugo Physicaltherapy & Sports Rehab

  • Physical Therapist
  • Mishawaka, IN
  • NPI 1427227115
  NPD (past)

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

• 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
• United Surgeons, LLC

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1518197011
  Care Compare affiliation

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1265427645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14950 STATE ROAD 23",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465307564",
            "telephone_number": "574-259-9668",
            "fax_number": "574-259-9671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14950 STATE ROAD 23",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465307564",
            "telephone_number": "574-259-9668",
            "fax_number": "574-259-9671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLMODIN",
        "first_name": "WALTER",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07000902A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000262667",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip Kline, R.PH.
• Ellen Klinedinst, MA EDS
• Amy Wolfe Knauff, MA CCC/SLP
• Marcia A Koelndorfer, LCSW
• Sarah Ann Kolacz, NP
• Gage Michael Koon, OD
• Payal Koul-Kumar, PT
• Hannah Kovac
• Elizabeth Kresse, PT
• Kevin R Kristl, M.D.

• Podiatrist in Granger, IN
• Providers in Granger, IN by specialty
• Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.