Samuel Dominic Kobba, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71000742A Issued in IN

Practice address

236 Simpson Ave
Elkhart, IN 46516-4666

Phone

(574) 293-0052

Fax

(574) 343-1390

NPI assigned

Mar 16, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heart City Health Center IncGroup PAC ID 9931008380, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18899/brand/1/csg/1/fhir/r4
• Direct secure messaging: samuel.kobba.1@11397.direct.athenahealth.com

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.

• Heart City Health Center, Inc.

  • Community Health Clinic/Center
  • Elkhart, IN
  • NPI 1720033418
  Medicare reassignment Care Compare group NPD
• Bridge Clinics Behavioral Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Indianapolis, IN
  • NPI 1326661836
  Medicare reassignment NPD
• Bridge Clinics LLC

  • Addiction Medicine (Family Medicine) Physician
  • Indianapolis, IN
  • NPI 1568935278
  Medicare reassignment NPD
• Eskenazi Medical Group Inc

  • Adult Medicine Physician
  • Indianapolis, IN
  • NPI 1730451063
  Medicare reassignment NPD
• The Health and Hospital Corporation of Marion County

  • Nurse Practitioner
  • Indianapolis, IN
  • NPI 1104027879
  Medicare reassignment NPD
• Heart City Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Elkhart, IN
  • NPI 1861034688
  NPD

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

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1811211154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5550 S EAST ST STE C",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462271991",
            "telephone_number": "317-534-4660",
            "fax_number": "317-782-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 SIMPSON AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465164666",
            "telephone_number": "574-293-0052",
            "fax_number": "574-343-1390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5550 S East St Ste C",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462271991",
            "country_code": "US",
            "telephone_number": "317-534-4660",
            "fax_number": "317-782-4301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOBBA",
        "first_name": "SAMUEL",
        "middle_name": "DOMINIC",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-16",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71000742A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toni Klatt-Ellis, CNS
• Bethany Grace Knaus, PHARMD
• Kevin Knaus, PHARMD, RPH
• Ernest Larry Knight, M.D.
• Hannah Rose Knouse, DPT
• Anne Kobold
• Kayla H Koch
• Richard Daniel Koch, LCSW
• Tina Marie Kocher, RN, NP
• Megan McGrew Koenig, D.O.

• Family Nurse Practitioner in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; 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.