SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH CAMPUS, INC (NPI# 1821402876) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821402876 |
| Entity Type | Organization |
| Organization Name | SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH CAMPUS, INC |
| Practice Address |
1915 Lake Ave Plymouth IN 46563-9366 |
| Mailing Address |
707 Cedar St Ste 200 Saint Joseph Physician Network-cbo South Bend IN 46617-2057 |
| Practice Telephone | 5749485000 |
| Practice Fax Number | 5749485454 |
| Mailing Telephone | 5743358700 |
| Mailing Fax Number | 5743350760 |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2016-10-27 |
| Authorized Official Name | MS. LORETTA SCHMIDT (PRESIDENT) |
| Authorized Official Telephone | 5749485478 |
| Is Organization Subpart | Y |
| Parent Organization Name | TRINITY HEALTH CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BCBS | 000000880530 | 01 |
| IN | 201268050A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538585187 | Saint Joseph Regional Medical Center Plymouth Campus, Inc | Family Medicine | 1919 Lake Ave Ste 102b, Plymouth, IN 46563-7830 | 2014-03-06 |
| Street Address |
1915 LAKE AVE |
| City | PLYMOUTH |
| State | IN |
| Zip Code | 46563-9366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619977543 | Guy Kedziora | Radiology | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2005-07-21 |
| 1598387250 | Dana Oberg | Hospitalist | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2020-05-15 |
| 1366905275 | Benjamin Cale Friesen | Registered Nurse | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2019-04-08 |
| 1902345879 | Aimee Clady | Nurse Practitioner | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2017-02-13 |
| 1013384262 | Jessica Cooper | Nurse Practitioner | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2015-08-24 |
| 1093102162 | Saint Joseph Regional Medical Center - Plymouth Campus Inc | Non-Pharmacy Dispensing Site | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2015-04-16 |
| 1144634742 | Christopher A Chesnut | Emergency Medicine | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2014-06-12 |
| 1669800728 | Muhammad M Hussain | Internal Medicine | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2013-10-28 |
| 1033430681 | Monica Esquivel | Dietitian, Registered | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2010-06-17 |
| 1184825283 | Brion B. Shin | Radiology | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2007-05-29 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 46563 | ||||
| Taxonomy Code | 208M00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Hospitalist |
| Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. |
| Notes: Source: American Society of Hospital Medicine, 2007. http://www.hospitalmedicine.org/ [7/1/2009: definition aded] Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions. There is no board certification for the specialty at this point. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598387250 | Dana Oberg | Hospitalist | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2020-05-15 |
| 1417344086 | Thomas Ku | Hospitalist | 275 Sandwich St, Plymouth, MA 02360 | 2015-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447865159 | Nichole Renee Sebesky | Hospitalist | 629 Park Dr, Franklin, IN 46131-7685 | 2020-09-10 |
| 1407239114 | Thomas Ryan Cervone | Hospitalist | Tristar Southern Hills Medical, 391 Wallace Road, Nashville, IN 37211 | 2015-06-30 |
| 1104194547 | Select Specialty Hospital - Evansville, LLC | Hospitalist | 400 Se 4th St, Evansville, IN 47713-1206 | 2011-12-13 |
| 1073826780 | Indiana University Health Starke Hospital LLC | Hospitalist | 102 East Culver Road, Knox, IN 46534-2216 | 2010-07-22 |
| 1295863199 | Jason S. Henderson | Hospitalist | 6404 Cotton Bay Dr N, Indianapolis, IN 46254-4528 | 2007-03-01 |
| 1619087707 | Shelene S. Ruggio | Hospitalist | 503 Steeplechase Dr, Auburn, IN 46706-9127 | 2006-08-30 |
| 1427161801 | Krishna Datta | Hospitalist | 2520 E. Dupont Road, Fort Wayne, IN 46825 | 2006-08-17 |
| 1003884404 | Srinivasu Kesa | Hospitalist | 3471 Muirfield Way, Carmel, IN 46032 | 2006-03-10 |
| 1154321099 | Johnson Memorial Hospital | Hospitalist | 1155 W Jefferson St, Ste 202, Franklin, IN 46131-2732 | 2005-07-21 |
| 1972152114 | Amber Banks | Hospitalist | 441 N Wabash Ave, Marion, IN 46952-2612 | 2019-09-10 |
| Find all providers with the same taxonomy | ||||
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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.