NPIMap

Organization Active NPI

Center for Sleep and Nasal Sinus Disorders, LLC

  • Sleep Medicine (Otolaryngology) Physician
  • South Bend, IN
National Provider Identifier
1568015485
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Otolaryngology) PhysicianTaxonomy code 207YS0012X
Legal business name
CENTER FOR SLEEP AND NASAL SINUS DISORDERS, LLC
Practice address
53760 Generations Dr
South Bend, IN 46635-1539
Phone
(888) 938-3838
Fax
(888) 919-1083
NPI assigned
Jul 19, 2019
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
Madan N KandulaNPI 1275521288
Title
Ceo
Phone
(888) 938-3838

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
Sleep Medicine (Otolaryngology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YS0012X Primary

Addresses

Primary practice location

53760 Generations Dr
South Bend, IN 46635-1539

Mailing address

10001 W Innovation Dr Ste 200
Milwaukee, WI 53226-4851
Phone (888) 938-3838

Other practice location 1

2012 S Main St Ste B
Goshen, IN 46526-5200
Phone (888) 938-3838

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190913002603 IN Part B Supplier - Clinic/Group Practice 7911236039 Receives reassigned benefits from 12 practitioners
Practice locations: Avon, IN; Goshen, IN; Indianapolis, IN; South Bend, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2261916Center for Sleep and Nasal Sinus Disorders, LLC53760 Generations Drive, South Bend, IN 46635Certificate of waiverJun 6, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2012 S Main St
Ste B
Goshen, IN 46526
Phone (574) 500-2010

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652659200000",
    "number": "1568015485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53760 GENERATIONS DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351539",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2012 S Main St Ste B",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465265200",
            "country_code": "US",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR SLEEP AND NASAL SINUS DISORDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-19",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A",
        "authorized_official_last_name": "KANDULA",
        "authorized_official_first_name": "MADAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-938-3838"
    },
    "taxonomies": [
        {
            "code": "207YS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, 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.
  • 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.