Individual provider Active NPI

Scott G Thomas, MD

  • Surgery Physician
  • South Bend, IN
National Provider Identifier
1033196126
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01037023A Issued in IN
Practice address
621 Memorial Dr
Suite 502
South Bend, IN 46601-1075
Phone
(574) 647-5875
Fax
(574) 647-5878
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01037023A IN Primary

Addresses

Primary practice location

621 Memorial Dr
Suite 502
South Bend, IN 46601-1075

Mailing address

3245 Health Drive
Suite 100
Granger, IN 46530-3245
Phone (574) 647-1840

Other practice location 1

500 Arcade Ave
Ste 320
Elkhart, IN 46514-2477
Phone (574) 523-7900

Other practice location 2

500 Arcade Ave
Ste 210
Elkhart, IN 46514-2485
Phone (574) 389-5656

Other identifiers 1

IdentifierTypeStateIssuer
100338820MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address THOMAS@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091222000338 IN Practitioner - General Surgery 6709865181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Indiana University School of Medicine, 1987
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)

621 Memorial Dr
Suite 502
South Bend, IN 46601-1075
Phone (574) 647-5875

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Nov 30, 2014 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Surgery CurrentSince Nov 30, 2014 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

500 Arcade Ave
Ste 320
Elkhart, IN 46514
Phone (574) 293-3317

500 Arcade Ave
Ste 210
Elkhart, IN 46514
Phone (574) 389-5656

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

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

621 Memorial Dr
Ste 302
South Bend, IN 46601
Phone (574) 236-1888

621 Memorial Dr
Ste 502
South Bend, IN 46601
Phone (574) 234-9001

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

Interoperability endpoints

  • Direct secure messaging: thomas@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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1033196126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DRIVE",
            "address_2": "SUITE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465303245",
            "telephone_number": "574-647-1840",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR",
            "address_2": "SUITE 502",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011075",
            "telephone_number": "574-647-5875",
            "fax_number": "574-647-5878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Arcade Ave",
            "address_2": "Ste 320",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142477",
            "country_code": "US",
            "telephone_number": "574-523-7900",
            "fax_number": "574-523-7909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Arcade Ave",
            "address_2": "Ste 210",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142485",
            "country_code": "US",
            "telephone_number": "574-389-5656",
            "fax_number": "574-523-7891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "SCOTT",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01037023A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100338820",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "THOMAS@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "621 Memorial Dr",
            "address_2": "Suite 502",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011063",
            "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.