Individual provider Active NPI

Kajal Patel Puranik, M.D.

  • Family Medicine Physician
  • Portage, IN
National Provider Identifier
1891135620
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01075990A Issued in IN
Practice address
3630 Willowcreek Rd
Portage, IN 46368-5075
Phone
(219) 364-3700
NPI assigned
Jun 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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 01075990A IN Primary

Addresses

Primary practice location

3630 Willowcreek Rd
Portage, IN 46368-5075

Mailing address

2022 Kelle Dr
Chesterton, IN 46304-8708
Phone (219) 364-3616

Other names 1

  • Dr. Kajal Patel Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kajal.puranik.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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160803000058 IN Practitioner - Family Practice 7113225392 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Porter Physician Services LLCGroup PAC ID 1850482407, 96 clinicians

Practice addresses (Care Compare)

3630 Willowcreek Rd
Portage Medical Group
Portage, IN 46368-5075
Phone (219) 364-3900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.68 of 100Reported as apm
Quality
76.2
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Porter Physician Services LLC Family Medicine CurrentSince Aug 1, 2016 Accepting new patients
Porter Physician Services LLC Family Medicine Past Accepting new patients

Locations

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

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

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

3630 Willowcreek Rd
Portage, IN 46368
Phone (219) 364-3000

85 E US Highway 6
Ste 220
Valparaiso, IN 46383
Phone (219) 402-5057

85 E US Highway 6
Valparaiso, IN 46383
Phone (219) 983-5743

813 Porter Campus Dr
Ste Abc
Valparaiso, IN 46383
Phone (219) 926-3000

Interoperability endpoints

  • Direct secure messaging: kajal.puranik.1@2340.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1891135620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 KELLE DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463048708",
            "telephone_number": "219-364-3616",
            "fax_number": "219-364-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685075",
            "telephone_number": "219-364-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURANIK",
        "first_name": "KAJAL",
        "middle_name": "PATEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01075990A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kajal.puranik.1@2340.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "3630 Willowcreek Rd",
            "city": "Portage",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463685075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAJAL",
            "last_name": "PATEL",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portage, IN

Sources for this page

Verify at the official NPI Registry.