Individual provider Active NPI

Kathryn L. Werda, MSPT, DPT, OCS

  • Orthopedic Physical Therapist
  • South Bend, IN
National Provider Identifier
1063502847
Registry record updated Jul 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
05011691A Issued in IN
Practice address
6301 University Commons
Suite 430
South Bend, IN 46635-1571
Phone
(574) 968-8251
Fax
(574) 968-2855
NPI assigned
Oct 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 05011691A IN Primary

Addresses

Primary practice location

6301 University Commons
Suite 430
South Bend, IN 46635-1571

Mailing address

6301 University Commons
Suite 230
South Bend, IN 46635-1571
Phone (574) 251-2100

Other identifiers 2

IdentifierTypeStateIssuer
201293020MedicaidIN
LAY68088OtherMABCBS OF MA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150701001972 IN Practitioner - Physical Therapist in Private Practice 5890704399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

301 E Day Rd
Mishawaka, IN 46545-3455
Phone (574) 204-6700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic LLC CurrentSince Oct 1, 2019 Accepting new patients
The South Bend Clinic, LLC CurrentSince Oct 1, 2019 Accepting new patients
J.B. Rehabilitation Associates, Inc Orthopedic CurrentSince Aug 19, 2002 Accepting new patients

Locations

301 E Day Rd
Mishawaka, IN 46545
Phone (574) 204-7300

6301 University Commons
Ste 430
South Bend, IN 46635
Phone (574) 968-2851

6301 University Commons
Ste 230
South Bend, IN 46635
Phone (574) 251-2115

515 N Lafayette Blvd
South Bend, IN 46601
Phone (219) 232-2037

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

104 Quarry St
Fl 1
Quincy, MA 02169
Phone (617) 770-4167

Interoperability endpoints

  • FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436745600000",
    "number": "1063502847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS",
            "address_2": "SUITE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351571",
            "telephone_number": "574-251-2100",
            "fax_number": "574-251-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS",
            "address_2": "SUITE 430",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351571",
            "telephone_number": "574-968-8251",
            "fax_number": "574-968-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERDA",
        "first_name": "KATHRYN",
        "middle_name": "L.",
        "credential": "MSPT, DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IN",
            "license": "05011691A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201293020",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MA",
            "identifier": "LAY68088",
            "state": "MA"
        }
    ],
    "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 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.