NPIMap

Organization Active NPI

Modern Vascular and Vein Center LLC

  • Vascular & Interventional Radiology Physician
  • Merrillville, IN
National Provider Identifier
1487176004
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
MODERN VASCULAR AND VEIN CENTER LLC
Practice address
8127 Merrillville Rd Ste 1
Merrillville, IN 46410-6306
Phone
(219) 208-6218
Fax
(475) 275-8031
NPI assigned
Jul 14, 2017
Last updated
May 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2022

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

Authorized official

Name
Nazar Golewale, MDNPI 1851548127
Title
Owner
Phone
(574) 334-0336

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X NU Primary

Addresses

Primary practice location

8127 Merrillville Rd Ste 1
Merrillville, IN 46410-6306

Mailing address

244 W Central Ave
Lombard, IL 60148-3813
Phone (219) 208-6218

Other practice location 1

244 W Central Ave
Lombard, IL 60148-3813
Phone (219) 208-6218

Other practice location 2

951 Transport Dr
Valparaiso, IN 46383-8434
Phone (574) 213-1327

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170802003474 IN Part B Supplier - Clinic/Group Practice 9335410703 Receives reassigned benefits from 9 practitioners
Practice locations: Merrillville, IN; Munster, IN
O20200129002634 IL Part B Supplier - Clinic/Group Practice 9335410703 Receives reassigned benefits from 3 practitioners
Practice locations: Palos Heights, IL; Homewood, IL; Addison, IL

National Provider Directory

National Provider Directory

Locations

9337 Calumet Ave
Munster, IN 46321
Phone (219) 836-2330

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652659200000",
    "number": "1487176004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 W CENTRAL AVE",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601483813",
            "telephone_number": "219-208-6218",
            "fax_number": "219-359-3679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8127 MERRILLVILLE RD STE 1",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106306",
            "telephone_number": "219-208-6218",
            "fax_number": "475-275-8031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "244 W Central Ave",
            "address_purpose": "LOCATION",
            "city": "Lombard",
            "state": "IL",
            "postal_code": "601483813",
            "country_code": "US",
            "telephone_number": "219-208-6218",
            "fax_number": "219-359-3679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "951 Transport Dr",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463838434",
            "country_code": "US",
            "telephone_number": "574-213-1327",
            "fax_number": "475-275-8031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MODERN VASCULAR AND VEIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-14",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A",
        "authorized_official_last_name": "GOLEWALE",
        "authorized_official_first_name": "NAZAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-334-0336",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.