Active NPI
Thomas L Hauch, MD
- Ophthalmology Physician
- South Bend, IN
National Provider Identifier
1023017902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 01031702A
- Practice address
- 53822 Generations Dr
South Bend, IN 46635-1543 - Phone
- (574) 233-3711
- Fax
- (574) 288-1702
- NPI assigned
- Jul 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Retina Specialist (Ophthalmology) Physician | 207WX0107X | 01031702A | IN | |
| Ophthalmology Physician | 207W00000X | 01031702A | IN | Primary |
Addresses
Primary practice location
53822 Generations Dr
South Bend, IN 46635-1543
Mailing address
53822 Generations Dr
South Bend, IN 46635-1543
Phone (574) 233-3711
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000550278 | Other | IN | ANTHEM |
| 200883090A | Medicaid | IN | |
| 000000085337 | Other | IN | BLUE SHIELD |
| 1785780 | Medicaid | MI | |
| 100223500 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01031702A | IN | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499817600000",
"number": "1023017902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53822 GENERATIONS DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351543",
"telephone_number": "574-233-3711",
"fax_number": "574-233-3711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53822 GENERATIONS DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351543",
"telephone_number": "574-233-3711",
"fax_number": "574-288-1702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAUCH",
"first_name": "THOMAS",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-21",
"last_updated": "2017-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "207WX0107X",
"taxonomy_group": "",
"desc": "Ophthalmology, Retina Specialist",
"state": "IN",
"license": "01031702A",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "01031702A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000550278",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200883090A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000000085337",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1785780",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100223500",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.