Guy Kedziora, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

01039718 Issued in IN

Practice address

1915 Lake Ave
Plymouth, IN 46563-9366

Phone

(574) 935-2353

Fax

(574) 935-2373

NPI assigned

Jul 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Radiation Oncology

Education

University of Tennessee, HSC, College of Medicine, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Michiana Hematology-Oncology P CGroup PAC ID 3375513419, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

98.47 of 100Reported as group

Quality

91.94

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Michiana Hematology-Oncology P C

  • Medical Oncology Physician
  • Mishawaka, IN
  • NPI 1619970183

  IN, Radiation Oncology

  Medicare reassignment Care Compare group NPD
• Radiation Oncology Associates of Michiana PC

  • Radiation Oncology Physician
  • South Bend, IN
  • NPI 1073569174

  Radiation Oncology

  NPD (past) Authorized official
• Michiana Hematology-Oncology P C

  • Hematology & Oncology Physician
  • Mishawaka, IN
  • NPI 1003955485
  Care Compare group
• Michiana Hematology-Oncology P C

  • Hematology & Oncology Physician
  • Plymouth, IN
  • NPI 1487793873
  NPD

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514937600000",
    "number": "1619977543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E WAYNE ST STE 510",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466012349",
            "telephone_number": "574-334-5390",
            "fax_number": "574-334-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 LAKE AVE",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465639366",
            "telephone_number": "574-935-2353",
            "fax_number": "574-935-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEDZIORA",
        "first_name": "GUY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2018-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IN",
            "license": "01039718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092080",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619977543",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jody Joseph, FNP
• Mark Jurek
• Angela Marie Kain
• Breanna Kartes, NP
• Katheryn'S Care
• Carla Ruthann Kelley, PTA
• Holly R. Kelly, N.P.
• Anna Joyce Kennel, FNP
• Brianna Kestle
• Julie Keyser

• All providers in Plymouth, IN
• Radiation Oncology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; 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.