Active NPI
Carol Valdez, N.P.
- Nurse Practitioner
- Mishawaka, IN
National Provider Identifier
1376948547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71005360
- Practice address
- 60101 Bodnar Blvd
Suite B
Mishawaka, IN 46544-9328 - Phone
- (574) 335-8500
- Fax
- (574) 335-0794
- NPI assigned
- Oct 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 28181527A | IN | |
| Nurse Practitioner | 363L00000X | 71005360 | IN | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
60101 Bodnar Blvd
Suite B
Mishawaka, IN 46544-9328
Mailing address
707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000919791 | Other | IN | BCBS |
| 201281160 | Medicaid | IN |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150422002416 | IN | Practitioner - Nurse Practitioner | 8921326943 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Joseph Regional Medical Center Inc
Practice addresses (Care Compare)
60101 Bodnar Blvd
Suite 100B
Mishawaka, IN 46544-9340
Phone (574) 335-8500
Hospital & facility affiliations
- Saint Joseph Regional Medical Center
- Memorial Hospital of South Bend
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28181527A | IN | MD | Emergency Registered Nurse |
| 71005360 | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center, Inc. | Nurse Practitioner | Current | Accepting new patients |
Locations
60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500
5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443
611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232
707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328
Interoperability endpoints
- cvaldez1141711@direct.trinity-health.org
Organizations & group practices 2
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.
-
- Pulmonary Disease Physician
- Plymouth, IN
- NPI 1225082878
IN, Nurse Practitioner
-
- Home Infusion Agency
- Mishawaka, IN
- NPI 1255369500
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1023965795
Hospital
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1841245594
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1376948547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 E CEDAR ST",
"address_2": "STE 200",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172057",
"telephone_number": "574-335-8700",
"fax_number": "574-335-0760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60101 BODNAR BLVD",
"address_2": "SUITE B",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465449328",
"telephone_number": "574-335-8500",
"fax_number": "574-335-0794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALDEZ",
"first_name": "CAROL",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-29",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "IN",
"license": "28181527A",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71005360",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000000919791",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201281160",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.