Kendra De Vries

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009822A Issued in IN

Practice address

503 Otis Bowen Dr
Munster, IN 46321-4158

Phone

(219) 703-5152

NPI assigned

Jan 2, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kendra Poel Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CBEIBA

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.

• Cardiovascular Consultants PC

  • Cardiovascular Disease Physician
  • Munster, IN
  • NPI 1538106711
  Medicare reassignment NPD

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1922647460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 OTIS BOWEN DR",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 OTIS BOWEN DR",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214158",
            "telephone_number": "219-703-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VRIES",
        "first_name": "KENDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28204066A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009822A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "POEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Ashbach MD PC
• Darija Davila
• Wafa Dawahir, MD
• Derek J Dawson, M.D.
• Jin Dawson
• Patricia Debosz, PA-C
• Sunil Dedhia, M.D.
• Joseph Deek
• Susan C Degroate, OTR
• Raionna Dejesus

• Family Nurse Practitioner in Munster, IN
• Providers in Munster, 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 Feb 20, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.