Individual provider Active NPI

Kelly Marszalek, MD

  • Family Medicine Physician
  • Mishawaka, IN
National Provider Identifier
1265846810
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01078730A Issued in IN
Practice address
611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468
Phone
(574) 335-6500
Fax
(574) 335-0772
NPI assigned
Jun 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11017605A IN
Family Medicine Physician 207Q00000X 01078730A IN Primary

Addresses

Primary practice location

611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468

Mailing address

6021 Mission TRL Apt 4
Granger, IN 46530-4021

Other practice location 1

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-5000

Other practice location 2

611 E Douglas Rd Ste 406
Mishawaka, IN 46545-1468
Phone (574) 335-6580

Other identifiers 1

IdentifierTypeStateIssuer
300005699MedicaidIN

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170822000898 IN Practitioner - Family Practice 4981829199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthlinc IncGroup PAC ID 7618929373, 83 clinicians
Chesterton Physical Therapy IncGroup PAC ID 3173683984, 191 clinicians

Practice addresses (Care Compare)

1001 Sturdy Rd
Valparaiso, IN 46383-4126
Phone 21946271732226

425 Sand Creek Dr
Suite C
Chesterton, IN 46304-1589

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01078730AINMDFamily Medicine Physician
11017605AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthlinc, Inc. Current Accepting new patients
Healthlinc, Inc CurrentSince Jun 1, 2024 Accepting new patients
Healthlinc, Inc CurrentSince Jun 1, 2024 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Family Medicine Past Accepting new patients

Locations

1313 W Chicago Ave
East Chicago, IN 46312
Phone (219) 397-1196

2106 Broadway St
East Chicago, IN 46312
Phone (219) 354-8910

2323 Broadway St
East Chicago, IN 46312

104 E Culver Rd
Ste 106
Knox, IN 46534
Phone (574) 772-7400

400 Teegarden St
Laporte, IN 46350
Phone (219) 326-0043

200 Alfred St
Michigan City, IN 46360
Phone (219) 224-2626

420 W 4th St
Mishawaka, IN 46544
Phone (574) 252-0300

1708 High St
South Bend, IN 46613
Phone (574) 237-6640

621 Memorial Dr
Ste 402
South Bend, IN 46601
Phone (574) 232-4800

1960 Northside Blvd
South Bend, IN 46615
Phone (574) 231-7228

1001 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 462-7173

701 Wall St
Valparaiso, IN 46383
Phone (219) 299-8419

2401 Valley Dr
Valparaiso, IN 46383
Phone (219) 413-5100

Organizations & group practices 5

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 3

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": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1265846810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6021 MISSION TRL APT 4",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465304021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 407",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451468",
            "telephone_number": "574-335-6500",
            "fax_number": "574-335-0772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5215 Holy Cross Pkwy",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465451469",
            "country_code": "US",
            "telephone_number": "574-335-5000",
            "fax_number": "574-335-4141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "611 E Douglas Rd Ste 406",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465451468",
            "country_code": "US",
            "telephone_number": "574-335-6580",
            "fax_number": "574-335-0818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSZALEK",
        "first_name": "KELLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-11",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11017605A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01078730A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300005699",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.