JORDAN GEROSKI (NPI# 1265962633) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265962633 |
| Entity Type | Individual |
| Full Name | JORDAN GEROSKI |
| Credential | DO |
| Practice Address |
111 W Jefferson Blvd Ste 100 South Bend IN 46601-1993 |
| Mailing Address |
111 W Jefferson Blvd Ste 100 South Bend IN 46601-1993 |
| Practice Telephone | 5746471669 |
| Mailing Telephone | 5746472624 |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2020-06-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | STATE LICENSE | 11019303A | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 611 E Douglas Rd Ste 137, Mishawaka, IN 465451464 | 5743356214 | |
| 611 E Douglas Rd Ste 407, Mishawaka, IN 465451468 | 5743356500 | 5743350770 |
| Street Address |
111 W JEFFERSON BLVD STE 100 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1993 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700231313 | Heather Saffel | Family Medicine | 111 W Jefferson Blvd Ste 100, South Bend, IN 46601-1993 | 2016-05-02 |
| 1821639477 | Lauren M Burish | Specialist/Technologist | 111 W Jefferson Blvd Ste 100, South Bend, IN 46601-1993 | 2019-10-04 |
| 1376020701 | Marcia Ritzert Barrett | Occupational Therapist | 111 W Jefferson Blvd Ste 100, South Bend, IN 46601-1993 | 2018-07-27 |
| 1568982437 | Erin Yeoman | Physical Therapist | 111 W Jefferson Blvd Ste 100, South Bend, IN 46601-1993 | 2017-06-22 |
| 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 | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255967352 | John R Majewski | Student in an Organized Health Care Education/Training Program | 1402 Portage Ave, South Bend, IN 46616-1733 | 2020-03-20 |
| 1023632114 | Dayna Gumm | Student in an Organized Health Care Education/Training Program | 4526 W Western Ave, South Bend, IN 46619-2302 | 2020-06-03 |
| 1457972499 | Megan Susanne Spencer | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-30 |
| 1588284079 | Madeline Grace Chandler | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-24 |
| 1255951968 | Kallie Kram | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1235759069 | Audrieanna Marie Kramer | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1417577271 | Deborah Michelle Pavey | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1841810702 | Kaitlin Vanderkolk | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-21 |
| 1982224879 | Allyson Nicole Dimagno | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-21 |
| 1609496686 | Garrett Muhlstadt | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-20 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
Please comment or provide details below to improve the information on JORDAN GEROSKI.
| 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.