NPIMap

Organization Active NPI

Michiana Eye Center LLC

  • Ophthalmology Physician
  • Goshen, IN
National Provider Identifier
1659670685
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MICHIANA EYE CENTER LLC
Practice address
1747 Stafford CT
Goshen, IN 46526
Phone
(574) 533-0100
Fax
(574) 534-3479
NPI assigned
Mar 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Authorized official

Name
Kevin R Baxter, DONPI 1609161686
Title
Owner/Ophthalmologist
Phone
(574) 271-3939

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X IN Primary
Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2082S0099X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1747 Stafford CT
Goshen, IN 46526

Mailing address

230 E Day Rd Ste 100
Mishawaka, IN 46545-3408
Phone (574) 271-3939

Other identifiers 2

IdentifierTypeStateIssuer
DA1128OtherINRR MEDICARE
100092980MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051208000136 IN Part B Supplier - Clinic/Group Practice 3173595634 Receives reassigned benefits from 15 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elkhart, IN; Goshen, IN; Mishawaka, IN; Plymouth, IN; South Bend, IN

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2216 Cassopolis St
Elkhart, IN 46514
Phone (574) 266-2111

1919 Lake Ave
Ste 103
Plymouth, IN 46563
Phone (574) 935-4480

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1659670685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E DAY RD STE 100",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453408",
            "telephone_number": "574-271-3939",
            "fax_number": "574-271-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 STAFFORD CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "46526",
            "telephone_number": "574-533-0100",
            "fax_number": "574-534-3479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA EYE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-16",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/OPHTHALMOLOGIST",
        "authorized_official_telephone_number": "574-271-3939",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": null,
            "primary": true
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DA1128",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092980",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.