Individual provider Active NPI

Diane Rene Sharkey, NP

  • Family Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1023549052
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71007256A Issued in IN
Practice address
610 N Michigan St Ste 400
South Bend, IN 46601-1081
Phone
(574) 647-8120
Fax
(574) 647-8111
NPI assigned
Mar 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 28094164A IN
Family Nurse Practitioner 363LF0000X 71007256A IN Primary

Addresses

Primary practice location

610 N Michigan St Ste 400
South Bend, IN 46601-1081

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other practice location 1

610 N Michigan St Ste 306
South Bend, IN 46601-1079
Phone (574) 647-6500

Other identifiers 1

IdentifierTypeStateIssuer
300005090MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address SHARKEY@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170817000734 IN Practitioner - Nurse Practitioner 9234401886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

610 N Michigan St
400 BMG Adv Cardiology Specialists
South Bend, IN 46601-1081
Phone (574) 647-8120

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28094164AINMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Family CurrentSince Sep 17, 2017 Accepting new patients
Beacon Medical Group Inc CurrentSince Sep 17, 2017 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

900 I St
Laporte, IN 46350
Phone (219) 324-1670

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

610 N Michigan St
Ste 400
South Bend, IN 46601
Phone (574) 204-7333

610 N Michigan St
Ste 306
South Bend, IN 46601
Phone (574) 647-6500

Interoperability endpoints

  • Direct secure messaging: sharkey@mybeacon.cernerdirect.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1023549052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N MICHIGAN ST STE 400",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011081",
            "telephone_number": "574-647-8120",
            "fax_number": "574-647-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 N Michigan St Ste 306",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011079",
            "country_code": "US",
            "telephone_number": "574-647-6500",
            "fax_number": "574-647-6518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHARKEY",
        "first_name": "DIANE",
        "middle_name": "RENE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28094164A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007256A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300005090",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SHARKEY@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "610 N Michigan St Ste 400",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.