NPIMap

Individual provider Active NPI

Sudhir Bhargav Vyakaranam, MD

  • Nephrology Physician
  • Mishawaka, IN
National Provider Identifier
1407019037
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01069102A Issued in IN
Practice address
710 Park PL
Mishawaka, IN 46545-3519
Phone
(574) 273-6767
Fax
(574) 968-7160
NPI assigned
Jul 3, 2008
Last updated
Apr 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT 187877 PA
Internal Medicine Physician 207R00000X 35095420 OH
Nephrology Physician 207RN0300X 01069102A IN Primary

Addresses

Primary practice location

710 Park PL
Mishawaka, IN 46545-3519

Mailing address

PO Box 5909
Portland, OR 97228-5909
Phone (574) 273-6767

Other identifiers 1

IdentifierTypeStateIssuer
201018440MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110607000399 IN Practitioner - NephrologyPractitioner - Internal Medicine 1850417973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology Physicians, LLCGroup PAC ID 1850289273, 11 clinicians

Practice addresses (Care Compare)

710 Park PL
Mishawaka, IN 46545-3519
Phone (574) 273-6767

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT 187877PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Chester Hospital LLC Internal Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: svyakaranam17511@direct.acumenmd.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1407019037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5909",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972285909",
            "telephone_number": "574-273-6767",
            "fax_number": "574-968-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 PARK PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453519",
            "telephone_number": "574-273-6767",
            "fax_number": "574-968-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VYAKARANAM",
        "first_name": "SUDHIR",
        "middle_name": "BHARGAV",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT 187877",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35095420",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01069102A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201018440",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.