Individual provider Active NPI

Kyle A. Kownacki, M.D.

  • Anesthesiology Physician
  • Mishawaka, IN
National Provider Identifier
1992115638
Registry record updated Jul 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
01078539A Issued in IN
Practice address
5215 Holy Cross Pkwy
Anesthesia Department
Mishawaka, IN 46545-1469
Phone
(574) 335-5000
NPI assigned
May 2, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 01078539A IN Primary

Addresses

Primary practice location

5215 Holy Cross Pkwy
Anesthesia Department
Mishawaka, IN 46545-1469

Mailing address

121 S Saint Louis Blvd
South Bend, IN 46617-2924
Phone (574) 233-3123

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
I20180710002600 IN Practitioner - Anesthesiology 1254557515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Indiana University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Anesthesiologists IncGroup PAC ID 6800837980, 91 clinicians

Practice addresses (Care Compare)

8111 S Emerson Ave
Indianapolis, IN 46237-8601
Phone (317) 528-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Anesthesiologists, Inc. Anesthesiology CurrentSince Oct 1, 2022 Accepting new patients

Locations

8111 S Emerson Ave
Indianapolis, IN 46237
Phone (317) 528-5261

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1398988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532044800000",
    "number": "1992115638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S SAINT LOUIS BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172924",
            "telephone_number": "574-233-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "address_2": "ANESTHESIA DEPARTMENT",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-335-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWNACKI",
        "first_name": "KYLE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-02",
        "last_updated": "2018-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01078539A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.