NPIMap

Individual provider Active NPI

Kimberland Sharesh Anderson, M.D.

  • Family Medicine Physician
  • Munster, IN
National Provider Identifier
1871738583
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01073217A Issued in IN
Practice address
7905 Calumet Ave
Munster, IN 46321-2549
Phone
(219) 836-3049
Fax
(219) 836-7295
NPI assigned
Dec 9, 2008
Last updated
Feb 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036123265 IL
Family Medicine Physician 207Q00000X 01073217A IN Primary

Addresses

Primary practice location

7905 Calumet Ave
Munster, IN 46321-2549

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

1101 Glendale Blvd Ste 102A
Valparaiso, IN 46383-3767
Phone (219) 464-9521

Other identifiers 3

IdentifierTypeStateIssuer
834340OtherILMEDICARE GROUP PTAN
201193760MedicaidIN
553180OtherILMEDICARE GROUP PTAN

Other names 1

  • Kimberland Sharesh Thompson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kimberland.anderson.1@2340.direct.athenahealth.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140110001163 IN Practitioner - Family Practice 6103964630 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

7905 Calumet Ave
Munster, IN 46321-2549
Phone (317) 865-8877

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network Family Medicine CurrentSince Aug 29, 2022 Accepting new patients
Porter Physician Services LLC Family Medicine CurrentSince Jun 10, 2017 Accepting new patients
Franciscan Physician Network CurrentSince Aug 29, 2022 Accepting new patients
Porter Health Services Family Medicine Past Accepting new patients
Northwest Indiana Nephrology PC Past Accepting new patients
Nephrology Associates of Northern Indiana, Inc Past Accepting new patients

Locations

2022 Kelle Dr
Chesterton, IN 46304
Phone (219) 364-3616

650 Dickinson Rd
Ste A
Chesterton, IN 46304
Phone (219) 926-2133

650 Dickinson Rd
Ste Z
Chesterton, IN 46304
Phone (219) 464-9507

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

7905 Calumet Ave
Munster, IN 46321
Phone (219) 836-5800

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

1101 Glendale Blvd
Ste 102A
Valparaiso, IN 46383
Phone (219) 263-7550

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kimberland.anderson.1@2340.direct.athenahealth.com

Organizations & group practices 6

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 7

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": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1871738583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7905 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212549",
            "telephone_number": "219-836-3049",
            "fax_number": "219-836-7295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Glendale Blvd Ste 102A",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463833767",
            "country_code": "US",
            "telephone_number": "219-464-9521",
            "fax_number": "219-465-1442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KIMBERLAND",
        "middle_name": "SHARESH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036123265",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01073217A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "834340",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201193760",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "553180",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kimberland.anderson.1@2340.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "1101 Glendale Blvd Ste 102A",
            "city": "Valparaiso",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463833767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIMBERLAND",
            "last_name": "THOMPSON",
            "middle_name": "SHARESH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.