NPIMap

Individual provider Active NPI

Nicole Lynn Kunar, DO

  • Family Medicine Physician
  • South Bend, IN
National Provider Identifier
1790149995
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02007936A Issued in IN
Practice address
1815 E Ireland Rd
South Bend, IN 46614-2845
Phone
(574) 647-1700
Fax
(574) 647-7572
NPI assigned
Apr 13, 2016
Last updated
Sep 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02007936A IN Primary

Addresses

Primary practice location

1815 E Ireland Rd
South Bend, IN 46614-2845

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
300094442MedicaidIN

Other names 1

  • Nicole Lynn Kranc Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191220000627 AZ Practitioner - Family Practice 1557656642 Reassigns benefits to 2 organizations
I20240910002181 IN Practitioner - Family Practice 1557656642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Nova Southeastern College of Osteo Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

1815 E Ireland Rd
Beacon Medical Group Ireland Road
South Bend, IN 46614-2845
Phone (574) 647-1700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Honorhealth Medical Group, LLC Current Accepting new patients
Beacon Medical Group, Inc. Family Medicine CurrentSince Oct 6, 2024 Accepting new patients
Honorhealth Medical Group, LLC CurrentSince Oct 28, 2019 Accepting new patients
Honorhealth Medical Group, LLC Family Medicine CurrentSince Oct 28, 2019 Accepting new patients
Honorhealth Ambulatory Current Accepting new patients
Beacon Medical Group Inc CurrentSince Oct 6, 2024 Accepting new patients
Scottsdale Healthcare Corporation Family Medicine CurrentSince Oct 28, 2019 Accepting new patients
Honorhealth Ambulatory CurrentSince Oct 28, 2019 Accepting new patients
Honorhealth Ambulatory Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

6220 W Bell Rd
Ste 100
Glendale, AZ 85308
Phone (602) 547-7200

6220 W Bell Rd
Ste 130
Glendale, AZ 85308
Phone (602) 547-7348

10230 W Happy Valley Pkwy
Ste 100C
Peoria, AZ 85383
Phone (623) 561-3030

2500 W Utopia Rd
Ste 100
Phoenix, AZ 85027
Phone (623) 683-4462

3311 N 44th St
Phoenix, AZ 85018
Phone (480) 882-7360

10510 N 92nd St
Ste 200
Scottsdale, AZ 85258
Phone (480) 323-1250

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

900 I St
Laporte, IN 46350
Phone (219) 324-1670

1815 E Ireland Rd
South Bend, IN 46614
Phone (574) 647-1700

Organizations & group practices 11

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1790149995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E IRELAND RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466142845",
            "telephone_number": "574-647-1700",
            "fax_number": "574-647-7572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNAR",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02007936A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300094442",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "KRANC",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.