NPIMap

Organization Active NPI

Michiana Eye Center LLC

  • Ophthalmology Physician
  • Mishawaka, IN
National Provider Identifier
1396722070
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MICHIANA EYE CENTER LLC
Practice address
230 E Day Rd
100
Mishawaka, IN 46545
Phone
(574) 271-3939
Fax
(574) 271-3941
NPI assigned
Dec 23, 2005
Last updated
Jun 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Authorized official

Name
Kevin R Baxter, DONPI 1609161686
Title
Owner/Ophthalmologist
Phone
(574) 271-3939

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Specialist 174400000X NU
Ophthalmology Physician 207W00000X NU Primary
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU

Addresses

Primary practice location

230 E Day Rd
100
Mishawaka, IN 46545

Mailing address

230 E Day Rd
100
Mishawaka, IN 46545-3408
Phone (574) 271-3939

Other identifiers 2

IdentifierTypeStateIssuer
100092980MedicaidIN
DA1128OtherINRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051208000136 IN Part B Supplier - Clinic/Group Practice 3173595634 Receives reassigned benefits from 15 practitioners
4 other NPIs on this enrollment
Practice locations: Elkhart, IN; Goshen, IN; Mishawaka, IN; Plymouth, IN; South Bend, IN
O20100930029696 IN DME Supplier - Physician - OphthalmologyDME Supplier - Physician - OptometristDME Supplier - Optician 3173595634 Practice locations: Mishawaka, IN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Michiana Eye Center LLC230 E Day Rd, Mishawaka, IN 46545-3408(574) 271-3939 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jun 1, 2003

National Provider Directory

National Provider Directory

Locations

1747 Stafford Ct
Goshen, IN 46526
Phone (574) 533-0100

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1396722070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E DAY RD",
            "address_2": "100",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453408",
            "telephone_number": "574-271-3939",
            "fax_number": "574-271-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 E DAY RD",
            "address_2": "100",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "46545",
            "telephone_number": "574-271-3939",
            "fax_number": "574-271-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA EYE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/OPHTHALMOLOGIST",
        "authorized_official_telephone_number": "574-271-3939",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092980",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA1128",
            "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 Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.