SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH CAMPUS, INC


Address: 1919 Lake Ave Ste 102b, Plymouth, IN 46563-7830
Phone: 5743356800

SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH CAMPUS, INC (NPI# 1538585187) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1538585187
Entity Type Organization
Organization Name SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH CAMPUS, INC
Other Organization Name SAINT JOSEPH FOOT AND ANKLE SPORTS MEDICINE INSTITUTE PLYMOUTH
Practice Address 1919 Lake Ave Ste 102b
Plymouth
IN 46563-7830
Mailing Address 707 Cedar St Ste 200
Saint Joseph Physician Network-cbo
South Bend
IN 46617-2057
Practice Telephone 5743356800
Practice Fax Number 5743350732
Mailing Telephone 5743358700
Mailing Fax Number 5743350760
Enumeration Date 2014-03-06
Last Update Date 2020-04-15
Authorized Official Name MS. LORETTA SCHMIDT (PRESIDENT)
Authorized Official Telephone 5749485478
Is Organization Subpart Y
Parent Organization Name TRINITY HEALTH CORPORATION

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207QS0010X Family Medicine
Specialization: Sports Medicine
Allopathic & Osteopathic Physicians
N 207R00000X Internal Medicine Allopathic & Osteopathic Physicians
N 208000000X Pediatrics Allopathic & Osteopathic Physicians
N 2081S0010X Physical Medicine & Rehabilitation
Specialization: Sports Medicine
Allopathic & Osteopathic Physicians
N 213E00000X Podiatrist Podiatric Medicine & Surgery Service Providers
N 213ES0103X Podiatrist
Specialization: Foot & Ankle Surgery
Podiatric Medicine & Surgery Service Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
Physician Assistants & Advanced Practice Nursing Providers
Y 207Q00000X Family Medicine Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IN 300036720 05
IN 201216910A 05
IN BCBS 000000875287 01

Other Provider/Organization Names

Other Name Type Code
Saint Joseph Foot and Ankle Sports Medicine Institute Plymouth Doing Business As Name - Organization
Saint Joseph Health Center Doing Business As Name - Organization

Provider Secondary Practice Location

Address Telephone Number Fax Number
510 W Adams St Ste 150, Plymouth, IN 465631789 5743353987 5743350850

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1821402876 Saint Joseph Regional Medical Center Plymouth Campus, Inc Internal Medicine 1915 Lake Ave, Plymouth, IN 46563-9366 2014-06-18

Office Location

Street Address 1919 LAKE AVE STE 102B
City PLYMOUTH
State IN
Zip Code 46563-7830

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780766261 Saint Joseph Regional Medical Center South Bend Campus, Inc. Family Medicine 1919 Lake Ave Ste 102b, Plymouth, IN 46563-7830 2006-10-20
1477066728 Karen Renee Hooker Registered Nurse 1919 Lake Ave Ste 102b, Plymouth, IN 46563-7830 2017-11-08
1154735181 Saint Joseph Regional Medical Center, Inc. Internal Medicine 1919 Lake Ave Ste 102b, Plymouth, IN 46563-7830 2014-06-18

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1811547748 Steven N Wolff Pharmacist Walmart #1978, 2505 North Oak Drive, Plymouth, IN 46563 2019-09-12
1295280923 Multi-county Ems LLC Ambulance 5034 Redwood Road, Plymouth, IN 46563 2016-08-23
1356473060 Donna Michelle Eggers Speech-Language Pathologist 1915 Lake Avenue, Plymouth, IN 46563 2007-03-09
1629103684 Marshall County Council On Aging Home Delivered Meals 1305 W Harrison Street, Plymouth, IN 46563 2007-02-22
1063561272 Associates In Clinical Psychology PC Psychiatric Residential Treatment Facility 317 West Monroe St, Plymouth, IN 46563 2007-01-09
1316005911 Michiana Eye Center LLC Optometrist 320 Meadow Ln, Plymouth, IN 46563 2006-12-05
1487722948 Allen Edward Reese Hearing Instrument Specialist 322 N. Michigan St., Suite C, Plymouth, IN 46563 2006-12-01
1508932252 Thomas A Miller Chiropractor 1071 Lincolnway E, Plymouth, IN 46563 2006-11-27
1679540991 Mukesh Garg Internal Medicine 2349 Lake Ave Ste 99, Plymouth, IN 46563 2006-03-06
1982686242 Woodlawn Hospital Skilled Nursing Facility 9601 Union Rd, Plymouth, IN 46563 2005-11-14
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1265996219 Housecall Physicians, Inc Family Medicine 31 Home Depot Drive, Suite 283, Plymouth, MA 02360 2019-01-24
1215445994 Jefferson Community Health Center Inc Family Medicine 316 N Madison Ave, Ste 200, Plymouth, NE 68424-4110 2018-01-17
1124551833 Xpress Urgent Care PC Family Medicine 49237 Fox Dr N, Plymouth, MI 48170-5205 2017-04-10
1952853525 Ann Curoe Family Medicine 10835 38th Pl N, Plymouth, MN 55441-1409 2016-10-31
1639429558 Carol Elizabeth Ness Family Medicine 1145 Shenandoah Ln N, Plymouth, MN 55447-3201 2012-09-18
1881953461 Ronald Carl Skoogberg Family Medicine 3025 Harbor Lane, Suite 101, Plymouth, MN 55447-5141 2012-05-16
1093955700 Soliman Home Visiting Physicians Pllc Family Medicine 12173 Chandler Dr, Plymouth, MI 48170-3193 2009-02-20
1457508079 Chaitra Channappa Family Medicine 31 Home Depot Dr Ste 283, Plymouth, MA 02360-2669 2008-08-26
1730365388 Milton Delin Westberg Family Medicine 1010 Wilson St, Plymouth, NC 27962-9185 2008-01-14
1194849398 Michael A Martella Family Medicine 515 E Mill Street, Plymouth, WI 53073-1807 2007-03-16
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Competitor

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City PLYMOUTH
Zip Code 46563

Improve Information

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Dataset Information

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.

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