MEDICARE: HEART GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	IN
2	207RI0011X	Interventional Cardiology Physician	IN
3	2086S0129X	Vascular Surgery Physician	IN
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	IN
5	363AM0700X	Medical Physician Assistant
6	207RC0000X	Cardiovascular Disease Physician	IN
7	363L00000X	Nurse Practitioner
8	363AS0400X	Surgical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487624102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART GROUP, PC

Provider Business Mailing Address
First Line	:	4015 GATEWAY BLVD
Second Line	:	SUITE 2120
City	:	NEWBURGH
State	:	IN
Zip	:	47630-9460
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-464-4485

Provider Business Practice Location Address
First Line	:	4015 GATEWAY BLVD
Second Line	:	SUITE 2120
City	:	NEWBURGH
State	:	IN
Zip	:	47630-9460
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-464-4485

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHANDRASHEKAR KUMBAR
Credential	:	MD
Telephone Number	:	812-464-9133

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	12/15/2016

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Directions to “HEART GROUP, PC ” Practice Location

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