Cardiac Care Consultants, PC

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

01040667 Issued in IN

Legal business name

CARDIAC CARE CONSULTANTS, PC

Practice address

1730 45TH Ave
Munster, IN 46321-3915

Phone

(219) 836-9677

Fax

(219) 836-0688

NPI assigned

Jul 17, 2006

Organization subpart

No

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

Authorized official

Name

Lourdes Canelas

Title

Administration

Phone

(219) 836-9677

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anuradha Divakaruni, M.D.

  • Interventional Cardiology Physician
  • Munster, IN
  • NPI 1902936586
  Medicare reassignment Care Compare group
• Shashidhar Divakaruni, M.D.

  • Interventional Cardiology Physician
  • Munster, IN
  • NPI 1902936578
  Medicare reassignment Care Compare group
• Mary Sajn, AGACNP-BC

  • Primary Care Nurse Practitioner
  • Munster, IN
  • NPI 1477141729
  Medicare reassignment NPD
• Ravi Kanakamedala, M.D.

  • Interventional Pain Medicine Physician
  • Munster, IN
  • NPI 1932108511
  NPD (past)
• Kiley Elizabeth Walker, PA-C

  • Physician Assistant
  • Munster, IN
  • NPI 1902475049
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1770501256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 45TH AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213915",
            "telephone_number": "219-836-9677",
            "fax_number": "219-836-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 45TH AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213915",
            "telephone_number": "219-836-9677",
            "fax_number": "219-836-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIAC CARE CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "CANELAS",
        "authorized_official_first_name": "LOURDES",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "219-836-9677"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IN",
            "license": "01040667",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "IN",
            "license": "01042616",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200465870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Interventional Cardiology Physician in Munster, IN
• Providers in Munster, IN by specialty
• Interventional Cardiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; 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.