Kobie I Douglas, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01071030A Issued in IN

Practice address

1100 W 6TH Ave
Gary, IN 46402-1711

Phone

(219) 885-4264

Fax

(219) 880-0182

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southlake Community Mental Health Center Inc.

  • Clinic/Center
  • Merrillville, IN
  • NPI 1821081290

  IN

  Medicare reassignment Care Compare group NPD
• Northshore Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Merrillville, IN
  • NPI 1114257300

  IN

  Medicare reassignment NPD
• Porter-Starke Services Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valparaiso, IN
  • NPI 1689627598

  IN

  Medicare reassignment NPD
• Southlake Community Mental Health Center Inc.

  • Psychiatric Hospital
  • Merrillville, IN
  • NPI 1548407216
  Care Compare group
• Southlake Community Mental Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
  • NPI 1376919217
  Care Compare group
• Southlake Community Mental Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hammond, IN
  • NPI 1609231927
  Care Compare group
• Southlake Community Mental Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hammond, IN
  • NPI 1134543960
  Care Compare group
• Southlake Community Mental Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Merrillville, IN
  • NPI 1477007292
  Care Compare group
• Southlake Community Mental Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hammond, IN
  • NPI 1508297540
  Care Compare group
• Northshore Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
  • NPI 1336992999
  NPD
• Northshore Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Portage, IN
  • NPI 1467490300

  Psychiatry

  NPD
• Porter-Starke Services Inc.

  • Federally Qualified Health Center (FQHC)
  • Valparaiso, IN
  • NPI 1659196236
  NPD

Specialty

Psychiatry

Education

Howard University College of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southlake Community Mental Health Center Inc 37 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kobie.douglas.p1@direct.northshorehealth.nextgenshare.com
• Direct secure messaging: kobie.douglas.p1@direct.geminus.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 22, 2013.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1497850663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 W 6TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464021711",
            "telephone_number": "219-885-4264",
            "fax_number": "219-882-0962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W 6TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464021711",
            "telephone_number": "219-885-4264",
            "fax_number": "219-880-0182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KOBIE",
        "middle_name": "I",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-115467",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01071030A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Discovery House Group
• Willie Timothy Donald Jr., TECHNICIAN
• Che-Ia D Donely-Wilson, RN
• Jordyn Taylor Dooley
• Acquinnetta Doughty
• April Drake
• Jenna Ducret
• Dungarvin Indiana, LLC
• Tenee Durr
• Emily Alice Strong Duym, MD

• All providers in Gary, IN
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.