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Individual provider Active NPI

Kevin C Anderson, MD

  • Orthopaedic Foot and Ankle Surgery Physician
  • South Bend, IN
National Provider Identifier
1427150796
Registry record updated Dec 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
01079147A Issued in IN
Practice address
100 Navarre PL Ste 4440
South Bend, IN 46601-1171
Phone
(574) 647-5300
Fax
(574) 647-5305
NPI assigned
Sep 5, 2006
Last updated
Dec 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 01079147A IN
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 01079147A IN Primary

Addresses

Primary practice location

100 Navarre PL Ste 4440
South Bend, IN 46601-1171

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 1

IdentifierTypeStateIssuer
300006370MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, NE2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20061128000557 MI Practitioner - Orthopedic Surgery 8729086822
I20230418002354 NE Practitioner - Orthopedic Surgery 8729086822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Michigan Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regional West Physicians ClinicGroup PAC ID 2062301609, 136 clinicians

Practice addresses (Care Compare)

2 W 42ND St
Scottsbluff, NE 69361-4669
Phone (308) 635-1717

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.07 of 100Reported as group
Quality
62.54
Promoting interoperability
98
Improvement activities
40
Cost
72.7

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01079147AINMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regional West Physicians Clinic Orthopaedic Surgery CurrentSince Apr 7, 2023 Accepting new patients
West Shore Health Centers Corporation Past Accepting new patients
West Shore Health Centers Corporation Past Accepting new patients
West Shore Health Centers Corporation Orthopaedic Surgery Past Accepting new patients
Medical X-Ray Consultants, LTD Past Accepting new patients
Wellbridge of Clarkston, LLC Past Accepting new patients
Regional West Physicians Clinic Past Accepting new patients

Locations

2 W 42nd St
Ste 120
Scottsbluff, NE 69361
Phone (308) 630-1717

3911 Avenue B
Ste 1100
Scottsbluff, NE 69361
Phone (308) 630-1355

3911 Avenue B
Ste G200
Scottsbluff, NE 69361
Phone (308) 630-1355

Organizations & group practices 7

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 2

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577664000000",
    "number": "1427150796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 4440",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011171",
            "telephone_number": "574-647-5300",
            "fax_number": "574-647-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KEVIN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "01079147A",
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "IN",
            "license": "01079147A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300006370",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.