NPIMap

Individual provider Active NPI

Kyle J Antos, O.D.

  • Optometrist
  • Laporte, IN
National Provider Identifier
1801024732
Registry record updated Aug 14, 2018
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Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003609A Issued in IN
Practice address
301 J St
Laporte, IN 46350
Phone
(219) 362-8923
Fax
(219) 324-8183
NPI assigned
Jun 30, 2009
Sex
Male
Sole proprietor
No

Organizations & group practices 16

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.

Medicare Care Compare profile

Specialty
Optometry
Education
Indiana University - School of Optometry, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Eye Consultants PC (71 clinicians)

Practice addresses (Care Compare)

837 N Cass St
Wabash, IN 46992-1613
Phone (888) 664-6148

Merit-based Incentive Payment System (MIPS)

Final score
55.99 of 100 (group)
Quality
31.67
Improvement activities
40
Cost
78.58

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20090915000755 IN Practitioner - Optometry 8527114685 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
18003609AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Eye Consultants, P.C. Current Accepting new patients
Midwest Eye Consultants, P.C. Optometrist Current
since Jul 13, 2009		 Accepting new patients
Midwest Eye Consultants, P.C. Optometrist Past Accepting new patients
Midwest Eye Consultants, P.C. Optometrist Past Accepting new patients
Midwest Eye Consultants P.C. Optometrist Past
since Jul 13, 2009		 Accepting new patients

Locations

374 Indian Boundary Rd
Chesterton, IN 46304
Phone (219) 395-1575

301 J St
#34
Laporte, IN 46350
Phone (219) 362-8923

301 J St
Laporte, IN 46350
Phone (219) 326-9569

17615 State Road 23
South Bend, IN 46635
Phone (574) 234-7600

837 N Cass St
Wabash, IN 46992
Phone (888) 664-6148

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18003609A IN Primary

Addresses

NPPES NPI Registry

Primary practice location

301 J St
Laporte, IN 46350

Mailing address

301 J St
Laporte, IN 46350-4734
Phone (219) 362-8923

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
200953020MedicaidIN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 14, 2018.

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1801024732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 J ST",
            "city": "LAPORTE",
            "state": "IN",
            "postal_code": "463504734",
            "telephone_number": "219-362-8923",
            "fax_number": "219-324-8183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 J ST",
            "city": "LAPORTE",
            "state": "IN",
            "postal_code": "46350",
            "telephone_number": "219-362-8923",
            "fax_number": "219-324-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOS",
        "first_name": "KYLE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-30",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003609A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200953020",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laporte, IN

Sources for this page

Verify at the official NPI Registry.