GREGG M EBERSOLE (NPI# 1093000366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093000366 |
| Entity Type | Individual |
| Full Name | GREGG M EBERSOLE |
| Credential | M.D. |
| Practice Address |
100 Navarre Pl Ste 4440 South Bend IN 46601-1171 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746475300 |
| Practice Fax Number | 5746475305 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2019-12-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 01079875A | IN | Allopathic & Osteopathic Physicians |
| Y | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
01079875A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | MEDICARE | 261970087 | 01 |
| IN | 300013151 | 05 |
| Street Address |
100 NAVARRE PL STE 4440 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1171 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982691762 | Bryan Boyer | Orthopaedic Surgery | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2005-10-05 |
| 1801412085 | Katelyn J Yoder | Nurse Practitioner | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2020-06-23 |
| 1649736604 | Meghan M. Hart | Physician Assistant | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2019-02-14 |
| 1700303070 | Bethanie L Wrobleski | Nurse Practitioner | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2017-08-27 |
| 1225551591 | Melissa Demetriou | Nurse Practitioner | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2017-07-19 |
| 1285164285 | Allison Linea Hartman | Nurse Practitioner | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2017-06-13 |
| 1588014914 | Jeanna Geddes | Nurse Practitioner | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2016-06-16 |
| 1407014442 | Joel M Post | Orthopaedic Surgery | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2008-05-27 |
| 1134399025 | Charisse D Johnson | Pediatrics | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2008-03-06 |
| 1912112384 | Christiaan Nikolaje Mamczak | Orthopaedic Surgery | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2007-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 207XS0114X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Adult Reconstructive Orthopaedic Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639340672 | Stephen F. Mitros, M.d., P.C. | Orthopaedic Surgery | 720 Cedar St Ste 160, South Bend, IN 46617-2093 | 2008-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407251382 | Thomas A Brady Sports Medicine Ctr | Orthopaedic Surgery | 1010 S Main St, Ste 100, Tipton, IN 46072-9753 | 2014-11-04 |
| 1871550053 | John Hur | Orthopaedic Surgery | 201 Pennsylvania Parkway, Suite 100, Indianapolis, IN 46280-1393 | 2006-04-29 |
| 1215440334 | Matthieu Zingg | Orthopaedic Surgery | 13000 E 136th St, Fishers, IN 46037-9478 | 2017-11-10 |
| 1043625361 | Phillip Bostian | Orthopaedic Surgery | 1801 N Senate Blvd Ste 535, Indianapolis, IN 46202-1204 | 2014-06-25 |
| 1518143163 | St. Francis Hospital and Health Centers | Orthopaedic Surgery | 701 E County Line Rd, Suite 204, Greenwood, IN 46143-1072 | 2008-01-14 |
| 1356547095 | Sakkapol Ongwijitwat | Orthopaedic Surgery | 7930 N Shadeland Ave, Indianapolis, IN 46250-2041 | 2007-06-21 |
| 1982770160 | Charles Leo Tremaine | Orthopaedic Surgery | 1950 45th Ave, Suite 200, Munster, IN 46321-3927 | 2006-11-28 |
| 1336101062 | Timothy J Williams | Orthopaedic Surgery | 1199 Hadley Rd, Mooresville, IN 46158-1788 | 2006-04-06 |
| 1083675656 | Joint Replacement Surgeons of Indiana | Orthopaedic Surgery | 1199 Hadley Rd, Mooresville, IN 46158-1788 | 2006-03-31 |
| City | SOUTH BEND |
| Zip Code | 46601 |
Please comment or provide details below to improve the information on GREGG M EBERSOLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.