Prabhakorn Kitbhoka, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

96918 Issued in GA

Practice address

710 Park PL
Mishawaka, IN 46545-3519

Phone

(574) 273-6787

Fax

(574) 968-7160

NPI assigned

Jul 20, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Nephrology

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Georgia Diagnostic Associates and Clinic, LLCGroup PAC ID 1951655737, 81 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
• Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pkitbhoka1147758@direct.trinity-health.org
• Direct secure messaging: pkitbhoka240977@samhealth.direct-ci.com
• Direct secure messaging: prabhakornkitbhoka@negaidx.allscriptsdirect.net

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.

• Northeast Georgia Diagnostic Associates and Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Gainesville, GA
  • NPI 1144719311
  Medicare reassignment Care Compare group NPD
• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385
  Medicare reassignment NPD
• Northeast Georgia Diagnostic Clinic LLC

  • Multi-Specialty Clinic/Center
  • Gainesville, GA
  • NPI 1215976634
  NPD (past)
• St. Mary'S Hospital, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1871556621
  NPD (past)

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

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Duluth, GA
  • NPI 1790715381
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Care Compare affiliation

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1679703045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5909",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972285909",
            "telephone_number": "574-273-6767",
            "fax_number": "574-968-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 PARK PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453519",
            "telephone_number": "574-273-6787",
            "fax_number": "574-968-7160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 McClure Bridge Rd",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300963131",
            "country_code": "US",
            "telephone_number": "770-476-3636",
            "fax_number": "770-476-5845",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3615 NW Samaritan Dr Ste 203",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973303771",
            "country_code": "US",
            "telephone_number": "541-768-6930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KITBHOKA",
        "first_name": "PRABHAKORN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-20",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01077845A",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OR",
            "license": "MD211417",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "96918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pkitbhoka240977@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3615 NW Samaritan Dr Ste 203",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Latrina Lyniece King
• Sandra K King
• Jonathan Edward Kintner, OD
• Lindsey Jon Kintner, OD
• Brenna Kirchhoff
• John L Kittredge, PA
• Roger Klauer, M.D.
• Casey Kleckner, PHARMACIST
• Alexis Ann Klotz, PHARMD
• Eric David Knapp, D.O.

• Nephrology Physician in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Nephrology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; 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.