MARY VAN KOOTEN (MD) – Family Medicine Physician, NPI 1619972601
Family Medicine Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,861 FAMILY PRACTICE in IN
Provider Addresses for MARY VAN KOOTEN (MD)
250 N SHADELAND AVE
INDIANAPOLIS, IN 462194959
Phone:
Type: Mailing
550 S LANDMARK AVE
BLOOMINGTON, IN 474033239
Phone: (812) 355-6900
Fax: (812) 333-5978
Type: Location
719, South Rogers Street, Bloomington, Monroe County, Indiana, 47403, United States
BLOOMINGTON, IN 474032335
Phone: (812) 330-0912
Fax: (812) 323-4465
Type: Location
Premier Healthcare Same Day Appointment / Walk In Clinic, 550, South Landmark Avenue, Bloomington, Monroe County, Indiana, 47403, United States
BLOOMINGTON, IN 474033239
Phone: (812) 355-6900
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-05-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050513000689 | I | Family Practice | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 207 | 176 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 101 | 86 | $0 |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 33 | 33 | $0 |
| G0009 | Administration of pneumococcal vaccine | 33 | 33 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 14 | 13 | $0 |
Insurance plans in this area (ZIP 46219)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pediatric Medicine | NC | |
| U R O L O G Y | IN | |
| Diagnostic Radiology, Interventional Radiology | NY | |
| Nurse Practitioner | IN | |
| P A T H O L O G Y | IN | |
| O T O L A R Y N G O L O G Y | IN | |
| E N D O C R I N O L O G Y | IN | |
| Family Practice, Sports Medicine | IN | |
| Gastroenterology, Internal Medicine | IN | |
| Orthopedic Surgery | MO |
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