Maureen Kozlow, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10003398A Issued in IN

Practice address

1500 S Lake Park Ave Ste 110
Hobart, IN 46342-6638

Phone

(219) 947-6017

Fax

(219) 947-6018

NPI assigned

Sep 9, 2021

Last updated

Oct 7, 2021By 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 2

Addresses

Other identifiers 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

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034
• Community Hospital Hospital, Munster, IN, CCN 150125
• St Catherine Hospital Inc Hospital, East Chicago, IN, CCN 150008
• Powers Health Rehabilitation Center Inpatient rehabilitation facility, Crown Point, IN, CCN 153045

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkozlow96794@ssdirect.comhs.org

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.

• Community Care Network Inc

  dba Powers Health Medical Group

  • Family Medicine Physician
  • Saint John, IN
  • NPI 1457610487

  Physician Assistant

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Stroke and Rehabilitation Center Inc

  dba Powers Health Rehabilitation Center

  • Rehabilitation Hospital
  • Crown Point, IN
  • NPI 1801301437

  Inpatient rehabilitation facility

  Care Compare affiliation
• Munster Medical Research Foundation Inc

  dba Community Hospital

  • General Acute Care Hospital
  • Munster, IN
  • NPI 1003918210
  Care Compare affiliation
• St Catherine Hospital Inc

  • General Acute Care Hospital
  • East Chicago, IN
  • NPI 1689776882
  Care Compare affiliation
• St Mary Medical Center Inc

  • General Acute Care Hospital
  • Hobart, IN
  • NPI 1558463745
  Care Compare affiliation
• St Mary Medical Center Inc

  dba St Mary Wound Clinic

  • General Acute Care Hospital
  • Hobart, IN
  • NPI 1962504175
  Care Compare affiliation

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1659040020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8558 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107032",
            "telephone_number": "219-392-7084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S LAKE PARK AVE STE 110",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426638",
            "telephone_number": "219-947-6017",
            "fax_number": "219-947-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZLOW",
        "first_name": "MAUREEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "00000000A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003398A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300054941",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan A Kobitka, MSW, LSW
• Theodora Koktsidis, HEALTH ADMINISTRATOR
• Lindsey Marie Kolakoski, PMHNP-BC
• Koppolu P Sarma MD Inc
• Christina M Korem, FNP-C
• Mary P Kustron
• Fadee Kutom, MD
• Labcorp Indiana Inc
• Laboratory Corporation of America Holdings
• Lake Park Clinic, P.C.

• Physician Assistant in Hobart, IN
• Providers in Hobart, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.