Zdzislaw Jerry Kosel, MD
Individual provider Active NPI Specialist · South Bend, IN
NPI 1821044637 · NPPES record last updated Oct 6, 2008
Key facts
- NPI
- 1821044637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 01056113A (IN)
- Practice address
- 416 E Monroe St
Ste 200
South Bend, IN 46601-2371 - Phone
- (574) 232-8119
- Fax
- (574) 288-0235
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Australia Anesthesia Management LLC
Practice addresses (Care Compare)
200 High Park Ave
Goshen, IN 46526-4810
Phone (574) 364-1000
Hospital & facility affiliations
- Goshen Hospital
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: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050202000811 | IN | Practitioner - Anesthesiology | 5991691784 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Australia Anesthesia Management LLC | Anesthesiology | Current |
Accepting new patients |
| Sheridan Healthcare of Indiana PC | Anesthesiology | Past | Accepting new patients |
| Goshen Anesthesiology LLC | Specialist | Past | Accepting new patients |
Locations
1605 Winsted Dr
Goshen, IN 46526
Phone (574) 271-0013
200 High Park Ave
Goshen, IN 46526
Phone (219) 533-2141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 01056113A | IN | Yes |
| Anesthesiology Physician | 207L00000X | 01056113A | IN |
Addresses
Primary practice location
416 E Monroe St
Ste 200
South Bend, IN 46601-2371
Mailing address
416 E Monroe St
Ste 200
South Bend, IN 46601-2371
Phone (574) 232-8119
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200381040 | Medicaid | IN |
Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.