GAURAV KUMAR M.D.
NPI 1225219462
Internal Medicine - Pulmonary Disease in Portage, IN

Active since November 15, 2007PECOS EnrolledAccepts Medicare Assignment
3156 WILLOWCREEK RD, PORTAGE, IN 46368(219) 762-9444 Get Directions Write a Review

NPPES record last updated: May 28, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 28, 2020, Aug 27, 2019 (2 updates tracked since 2019).

About Gaurav Kumar M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GAURAV KUMAR M.D. (NPI 1225219462) is an individual pulmonary disease provider in Portage, Indiana, licensed in Indiana (01065464A) and active in the NPI registry since November 2007. He is enrolled in Medicare PECOS, is affiliated with Methodist Hospitals Inc, and is a graduate of University Of Missouri, Kansas City, School Of Medicine (2006).

NPPES Registry Identity

NPI1225219462
Entity TypeIndividualMale
Primary Taxonomy207RP1001X
Provider Legal NameGAURAV KUMARCredential: M.D.
Location Address3156 WILLOWCREEK RDPortage, IN 46368-4424
Mailing Address2700 Valparaiso St #2001, # 2001Valparaiso, IN 46384-2001 · (219) 762-9444
Sole ProprietorYes
Medical School CMSUniversity Of Missouri, Kansas City, School Of MedicineGraduated 2006
Enumeration DateNovember 15, 2007
Last NPPES UpdateMay 28, 20202 updates tracked since enumeration
NPPES CertifiedMay 28, 2020
NPI 1225219462 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
License Licensed in IN · 01065464A
Definition
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.
Also ListedInternal MedicineTaxonomy 207R00000X · License 01065464A (IN)
Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License 01065464A (IN)
3156 WILLOWCREEK RD, Portage, IN 46368

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Gaurav Kumar M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9638365653
PECOS Enrollment IDI20110629000618
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 20

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
857 services291 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
474 services315 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
405 services133 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
370 services196 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
337 services267 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
276 services221 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Methodist Hospitals Inc

Acute Care Hospitals · Gary, IN
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150002
Location600 Grant StGary, IN 46402 · Lake County
Emergency services Birthing friendly

St Catherine Hospital Inc

Acute Care Hospitals · East Chicago, IN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150008
Location4321 Fir StreetEast Chicago, IN 46312 · Lake County
Emergency services Birthing friendly

Union Hospital Inc

Acute Care Hospitals · Terre Haute, IN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150023
Location1606 N Seventh StTerre Haute, IN 47804 · Vigo County
Emergency services Birthing friendly

St Mary Medical Center Inc

Acute Care Hospitals · Hobart, IN
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150034
Location1500 S Lake Park AveHobart, IN 46342 · Lake County
Emergency services Birthing friendly

Northwest Health - Porter

Acute Care Hospitals · Valparaiso, IN
3/5 CMS rating
OwnershipProprietary
CMS Certification Number150035
Location85 East Us Hwy 6Valparaiso, IN 46383 · Porter County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46368 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$122.49 typical visit price
range $53.07 – $161.76
Typical copayment $30.62 (range $13.26 – $40.44)
Most-billed visit code 99204
Established Patient
$94.22 typical visit price
range $16.93 – $132.22
Typical copayment $23.55 (range $4.23 – $33.05)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
29%749 patients2/55-star benchmark: 85%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
38%174 patients2/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
97%7,095 patients4/55-star benchmark: 99%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
79%1,180 patients4/55-star benchmark: 88%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
99%408 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
11%1,249 patients1/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
20%1,265 patients1/55-star benchmark: 97%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
72%1,249 patients3/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
34%1,249 patients2/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
27%1,249 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 42

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
15 suppliers66 claims229 services$6.01 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
9 suppliers30 claims54 services$0.99 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
7 suppliers51 claims51 services$33.49 avg. paid by Medicare
Tracheostomy, inner cannula A4623
DME-Orthotic Devices · category DF000N
2 suppliers19 claims842 services$6.31 avg. paid by Medicare
Tracheal suction catheter, any type other than closed system, each A4624
DME-Other DME · category DE000N
1 supplier12 claims1,080 services$2.01 avg. paid by Medicare
Canister, disposable, used with suction pump, each A7000
DME-Other DME · category DE000N
4 suppliers18 claims24 services$7.09 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Acute Care)
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Internal Medicine
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Physical Medicine & Rehabilitation (Pain Medicine)
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Nurse Practitioner (Adult Health)
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Physical Medicine & Rehabilitation
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Internal Medicine (Pulmonary Disease)
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Psychiatry & Neurology (Neurology)
3156 WILLOWCREEK RD
PORTAGE, IN 46368
Nurse Practitioner
3156 WILLOWCREEK RD
PORTAGE, IN 46368

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gaurav Kumar's NPI number?

The NPI number for Gaurav Kumar is 1225219462. It was assigned to this individual provider in the NPPES registry on November 15, 2007.

Where is Gaurav Kumar located?

Gaurav Kumar practices at 3156 Willowcreek Rd, Portage, IN 46368. The listed phone number is (219) 762-9444.

What is Gaurav Kumar's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Gaurav Kumar enrolled in Medicare?

Yes. Gaurav Kumar is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Gaurav Kumar accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Gaurav Kumar as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Gaurav Kumar affiliated with any hospitals?

According to CMS data, Gaurav Kumar is affiliated with Methodist Hospitals Inc, St Catherine Hospital Inc, Union Hospital Inc, St Mary Medical Center Inc and Northwest Health - Porter.

When was this NPI record last updated?

The NPPES record for Gaurav Kumar was last updated on May 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.