ALLIED PHYSICIANS OF MICHIANA, LLC (NPI# 1508191768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508191768 |
| Entity Type | Organization |
| Organization Name | ALLIED PHYSICIANS OF MICHIANA, LLC |
| Other Organization Name | GENERAL & VASCULAR SURGERY |
| Practice Address |
621 Memorial Dr Suite 302 South Bend IN 46601-1063 |
| Mailing Address |
6301 University Commons Suite 230 South Bend IN 46635-1571 |
| Practice Telephone | 5742361888 |
| Practice Fax Number | 5742361887 |
| Mailing Telephone | 5742512100 |
| Mailing Fax Number | 5742512150 |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2017-01-10 |
| Authorized Official Name | SHERY A. ROUSSARIE (CEO) |
| Authorized Official Telephone | 5742512100 |
| Is Organization Subpart | Y |
| Parent Organization Name | ALLIED PHYSICIANS OF MICHIANA, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200962980W | 05 | |
| IN | 200962980G | 05 | |
| IN | 200962980H | 05 | |
| IN | 200962980V | 05 | |
| IN | 200962980N | 05 |
| Other Name | Type Code |
|---|---|
| General & Vascular Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154832178 | Allied Physicians of Michiana, LLC | Surgery | 611 E Douglas Rd Ste 308, Mishawaka, IN 46545-1465 | 2017-10-17 |
| 1902200298 | Allied Physicians of Michiana, LLC | Durable Medical Equipment & Medical Supplies | 1919 Lake Ave, Suite 107b, Plymouth, IN 46563-7830 | 2014-10-15 |
| 1356745657 | Allied Physicians of Michiana, LLC | Durable Medical Equipment & Medical Supplies | 1120 W South St, Bremen, IN 46506-1849 | 2014-10-15 |
| 1295139723 | Allied Physicians of Michiana, LLC | Durable Medical Equipment & Medical Supplies | 6301 University Commons, Suite 100, South Bend, IN 46635-1571 | 2014-10-13 |
| 1013310192 | Allied Physicians of Michiana, LLC | Durable Medical Equipment & Medical Supplies | 2349 Lake Ave, Suite 201, Plymouth, IN 46563-7835 | 2014-10-02 |
| 1588916258 | Allied Physicians of Michiana, LLC | Obstetrics & Gynecology | 6301 University Commons, Suite 230, South Bend, IN 46635-1571 | 2012-10-05 |
| 1265714778 | Allied Physicians of Michiana, LLC | Occupational Therapist | 6301 University Commons, Suite 430, South Bend, IN 46635-1571 | 2011-09-12 |
| 1336438647 | Allied Physicians of Michiana, LLC | Orthopaedic Surgery | 6301 University Commons, Suite 420, South Bend, IN 46635-1571 | 2011-04-07 |
| 1114259074 | Allied Physicians of Michiana, LLC | Pediatrics | 6301 University Commons, Suite 320, South Bend, IN 46635-1571 | 2010-02-03 |
| 1912232828 | Allied Physicians of Michiana, LLC | Obstetrics & Gynecology | 6301 University Commons, Suite 310, South Bend, IN 46635-1571 | 2009-10-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | ALLIED PHYSICIANS OF MICHIANA, LLC | 6301 University Commons, Suite230, South Bend, IN 46635-1571 |
| Street Address |
621 MEMORIAL DR SUITE 302 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003818212 | John L Jenkins | Specialist | 621 Memorial Dr, Ste 502, South Bend, IN 46601-1075 | 2005-06-01 |
| 1447783188 | Khonnah Weithers | Nurse Practitioner | 621 Memorial Dr, Suite 512, South Bend, IN 46601-1063 | 2017-04-10 |
| 1619388717 | Sarah Ann Holewczynski | Registered Nurse | 621 Memorial Dr, Ste 617, South Bend, IN 46601-1063 | 2014-05-12 |
| 1518302264 | Beacon Medical Group, Inc. | Nurse Practitioner | 621 Memorial Dr, Suite 602, South Bend, IN 46601-1063 | 2013-05-08 |
| 1255620985 | David L. Clayton Md Inc | Family Medicine | 621 Memorial Dr, Suite 624, South Bend, IN 46601-1063 | 2011-04-04 |
| 1477873644 | Rebecca M Castro | Nurse Practitioner | 621 Memorial Dr, Ste 502, South Bend, IN 46601-1063 | 2010-06-10 |
| 1841434354 | Kelly Elizabeth Mortell | Radiology | 621 Memorial Dr, Ste 312, South Bend, IN 46601-1063 | 2009-04-28 |
| 1659543643 | William Hanley | Nurse Practitioner | 621 Memorial Dr, Suite 502, South Bend, IN 46601-1063 | 2008-03-31 |
| 1134262595 | North Central Neurology, LLC | Psychiatry & Neurology | 621 Memorial Dr, Suite 624, South Bend, IN 46601-1063 | 2007-02-15 |
| 1619015534 | Beacon Medical Group, Inc. | Specialist | 621 Memorial Dr, Suite 502, South Bend, IN 46601-1063 | 2007-02-02 |
| 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 | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538136361 | Mark A Thompson | Surgery | 621 Memorial Dr Ste 502, South Bend, IN 46601-1075 | 2006-03-01 |
| 1174927131 | Beacon Medical Group, Inc. | Surgery | 621 Memorial Dr Ste 502, South Bend, IN 46601-1075 | 2014-10-20 |
| 1326459108 | Katherine Delayne Goze | Surgery | 621 Memorial Dr Ste 502, South Bend, IN 46601-1075 | 2014-05-14 |
| 1821314360 | Justin Jacob Koenig | Surgery | 621 Memorial Dr Ste 502, South Bend, IN 46601 | 2010-04-08 |
| 1013907781 | Robert G. Credi | Surgery | 211 N Eddy St, South Bend, IN 46617-2808 | 2005-10-25 |
| 1679562383 | Alfredo V Casetti | Surgery | 211 N Eddy St, South Bend, IN 46617-2808 | 2005-10-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902416076 | Elkhart Clinic, LLC | Surgery | 2240 Karisa Dr Ste 1, Goshen, IN 46526-6943 | 2020-08-04 |
| 1053920314 | Little Company of Mary Hospital of Indiana Inc | Surgery | 1025 1st Ave W Ste B, Jasper, IN 47546-3217 | 2020-07-23 |
| 1013568724 | Amber D Petty | Surgery | 2401 W University Ave Ste 403, Muncie, IN 47303-3428 | 2019-09-24 |
| 1972162246 | Christopher Anthony Lawton | Surgery | 635 Barnhill Dr Ste 116, Indianapolis, IN 46202-5126 | 2019-06-11 |
| 1013436922 | Stephen Neil Quigley | Surgery | 550 University Blvd # Uh1295, Indianapolis, IN 46202-5149 | 2017-09-12 |
| 1821512138 | Decatur County Memorial Hospital | Surgery | 731 N Lincoln St, Greensburg, IN 47240-1328 | 2017-07-28 |
| 1881120434 | Henry Lee Roberts | Surgery | 545 Barnhill Dr # 125, Indianapolis, IN 46202 | 2017-05-02 |
| 1891189171 | Werner Heinrich Henning | Surgery | 1230 Colinbrook Cir, Greenwood, IN 46143-3608 | 2015-03-24 |
| 1962806851 | Shotaro Sano | Surgery | 2451 Intelliplex Dr Ste 280, Shelbyville, IN 46176-8580 | 2014-10-21 |
| 1336540814 | Fredrick Allen Hillis | Surgery | 374 S Shore Dr, Culver, IN 46511-8908 | 2014-09-15 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
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| 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.