Individual provider Active NPI

Kevin Andre Myrie, M.D,

  • Nephrology Physician
  • Merrillville, IN
National Provider Identifier
1316193162
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
1071201A Issued in IN
Practice address
90 W 86TH Ave
Nephrology Associates of Northern Indiana
Merrillville, IN 46410-7086
Phone
(219) 791-1555
Fax
(219) 791-1560
NPI assigned
Aug 12, 2008
Last updated
Dec 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036123789 IL
Nephrology Physician 207RN0300X 1071201A IN Primary

Addresses

Primary practice location

90 W 86TH Ave
Nephrology Associates of Northern Indiana
Merrillville, IN 46410-7086

Mailing address

120 W 22ND St Ste 200
Oak Brook, IL 60523-1563
Phone (630) 573-5000

Other identifiers 1

IdentifierTypeStateIssuer
201077180MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@nephdocs.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120725000576 IN Practitioner - Nephrology 3173676350 Reassigns benefits to 1 organization
I20170323001393 IL Practitioner - Nephrology 3173676350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates of Northern Indiana PCGroup PAC ID 8921033440, 64 clinicians

Practice addresses (Care Compare)

7836 W Jefferson Blvd
101 Nephrology Associates of Northern India
Fort Wayne, IN 46804-4178
Phone (260) 494-3484

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036123789ILMDNephrology Physician
1071201AINMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Northern Indiana, Inc Nephrology CurrentSince Jul 1, 2012 Accepting new patients
Northwestern Memorial Physicians Group Past Accepting new patients

Locations

120 W 22nd St
Oak Brook, IL 60523

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

7836 W Jefferson Blvd
Ste 101
Fort Wayne, IN 46804

569 Tyler St
Gary, IN 46402
Phone (260) 885-3300

90 W 86th Ave
Merrillville, IN 46410
Phone (219) 791-1555

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kmyrie41359@direct.acumenmd.com
  • Direct secure messaging: kmyrie99407@direct.franciscanalliance.org

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1316193162",
    "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",
            "address_2": "NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107086",
            "telephone_number": "219-791-1555",
            "fax_number": "219-791-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYRIE",
        "first_name": "KEVIN",
        "middle_name": "ANDRE",
        "name_prefix": "Dr.",
        "credential": "M.D,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-12",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036123789",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "1071201A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201077180",
            "state": "IN"
        }
    ],
    "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

Verify at the official NPI Registry.