Kayti Lynn Bonczynski, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71006807A Issued in IN

Practice address

621 Memorial Dr Ste 402
South Bend, IN 46601-1074

Phone

(574) 400-4550

Fax

(574) 400-4551

NPI assigned

Sep 15, 2016

Last updated

Jan 3, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthlinc IncGroup PAC ID 7618929373, 83 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Healthlinc, Inc.

  • Federally Qualified Health Center (FQHC)
  • Valparaiso, IN
  • NPI 1528262581
  Medicare reassignment Care Compare group NPD
• Healthlinc, Inc

  dba HealthLinc - Newton

  • Federally Qualified Health Center (FQHC)
  • Morocco, IN
  • NPI 1568354116
  NPD
• Healthlinc, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mishawaka, IN
  • NPI 1417244989
  NPD

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1619425980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 402",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011074",
            "telephone_number": "574-400-4550",
            "fax_number": "574-400-4551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 402",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011074",
            "telephone_number": "574-400-4550",
            "fax_number": "574-400-4551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52500 Fir Rd",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308579",
            "country_code": "US",
            "telephone_number": "574-271-0700",
            "fax_number": "574-273-5648",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "420 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465441948",
            "country_code": "US",
            "telephone_number": "574-307-7673",
            "fax_number": "574-307-7692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONCZYNSKI",
        "first_name": "KAYTI",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-15",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006807A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kayti.bonczynski@healthlinc.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "420 W 4th St",
            "city": "Mishawaka",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465441948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Bonded by Blood
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• Family Nurse Practitioner in South Bend, IN
• Providers in South Bend, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; 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.