Individual provider Active NPI

Kenneth O Madler, MA, CCC-A

  • Audiologist-Hearing Aid Fitter
  • Winchester, IN
National Provider Identifier
1922159078
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
23002191A Issued in IN
Practice address
115 S Main St
Winchester, IN 47394-1822
Phone
(765) 584-4327
Fax
(765) 584-3677
NPI assigned
Jan 16, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X 23002191A IN Primary

Addresses

Primary practice location

115 S Main St
Winchester, IN 47394-1822

Mailing address

115 S Main St
Winchester, IN 47394-1822
Phone (765) 584-4327

Other identifiers 2

IdentifierTypeStateIssuer
000000294346OtherINANTHEM BCBS PROV NUMBER
200443140MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090604000340 IN Practitioner - Qualified Audiologist 3779633235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

113 S Main St
Winchester, IN 47394-1822
Phone (765) 584-4327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
23002191AINMDAudiologist-Hearing Aid Fitter

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1922159078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 S MAIN ST",
            "city": "WINCHESTER",
            "state": "IN",
            "postal_code": "473941822",
            "telephone_number": "765-584-4327",
            "fax_number": "765-584-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S MAIN ST",
            "city": "WINCHESTER",
            "state": "IN",
            "postal_code": "473941822",
            "telephone_number": "765-584-4327",
            "fax_number": "765-584-3677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADLER",
        "first_name": "KENNETH",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "credential": "MA, CCC-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "IN",
            "license": "23002191A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROV NUMBER",
            "identifier": "000000294346",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200443140",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.