Active NPI
Camille M Kureth, M.D.
- Pediatrics Physician
- Mishawaka, IN
National Provider Identifier
1699743849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 01071180B
- Practice address
- 611 E Douglas Rd
Mishawaka, IN 46545-1464 - Phone
- (574) 335-6242
- Fax
- (574) 335-6243
- NPI assigned
- Mar 14, 2006
- Last updated
- Sep 14, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01071180B | IN | Primary |
| Pediatrics Physician | 208000000X | 4301036427 | MI |
Addresses
Primary practice location
611 E Douglas Rd
Mishawaka, IN 46545-1464
Mailing address
707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201067770 | Medicaid | IN | |
| 4827848/10 | Medicaid | MI | |
| 000000200925 | Other | IN | BCBS - COMM PEDS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01071180B | IN | MD | Pediatrics Physician |
| 4301036427 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Pediatric & Adolescent Medicine | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Troy, MI
- NPI 1356440572
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1699743849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 E CEDAR ST",
"address_2": "STE 200",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172057",
"telephone_number": "574-335-8700",
"fax_number": "574-335-0760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 E DOUGLAS RD",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451464",
"telephone_number": "574-335-6242",
"fax_number": "574-335-6243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KURETH",
"first_name": "CAMILLE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-14",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01071180B",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301036427",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201067770",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4827848/10",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - COMM PEDS",
"identifier": "000000200925",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.