NPIMap

Individual provider Active NPI

Lily Kristine Sunio, M.D,

  • Nephrology Physician
  • Mishawaka, IN
National Provider Identifier
1467683904
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01073784A Issued in IN
Practice address
710 Park PL
Mishawaka, IN 46545-3519
Phone
(574) 273-6767
Fax
(574) 273-6757
NPI assigned
Jul 31, 2009
Last updated
Apr 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

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 4301094169 MI
Internal Medicine Physician 207R00000X 01073784A IN
Nephrology Physician 207RN0300X 01073784A 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
201235040MedicaidIN

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
I20140805002905 IN Practitioner - NephrologyPractitioner - Internal MedicinePractitioner - Neurology 8224255856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2002
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
01073784AINMDInternal Medicine Physician
4301094169MIMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: lsunio17509@direct.acumenmd.com

Organizations & group practices 1

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 11

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": "1248998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1467683904",
    "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": "574-273-6757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNIO",
        "first_name": "LILY",
        "middle_name": "KRISTINE",
        "name_prefix": "Dr.",
        "credential": "M.D,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-31",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301094169",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01073784A",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01073784A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201235040",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.