Individual provider Active NPI

Nathaniel Robert Stewart, MD

  • Family Medicine Physician
  • Granger, IN
National Provider Identifier
1063773422
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01073332A Issued in IN
Practice address
12563 State Rd 23
Granger, IN 46530-9226
Phone
(574) 335-8300
Fax
(574) 335-0775
NPI assigned
Jun 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01073332A IN Primary

Addresses

Primary practice location

12563 State Rd 23
Granger, IN 46530-9226

Mailing address

707 Cedar St Ste 200
South Bend, IN 46617-2057

Other practice location 1

1949 Hospital Dr
Martinsville, IN 46151-1861
Phone (765) 342-8383

Other practice location 2

1122 S Ironwood Dr
South Bend, IN 46615
Phone (574) 335-8399

Other identifiers 1

IdentifierTypeStateIssuer
201087310MedicaidIN

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
I20141021002161 IN Practitioner - Internal MedicinePractitioner - Family PracticePractitioner - Emergency Medicine 3173751534 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine, Family Practice
Education
Indiana University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1122 S Ironwood Dr
River Park Family Medicine
South Bend, IN 46615-1618
Phone (574) 335-8399

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. CurrentSince Jun 1, 2022 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc Current Accepting new patients
Saint Joseph Regional Medical Center, Inc. Current Accepting new patients
Iu Health Morgan Physicians, LLC Family Medicine CurrentSince Aug 3, 2015 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. Family Medicine CurrentSince Jun 1, 2022 Accepting new patients

Locations

2738 Solution Ctr
Chicago, IL 60677

2209 John R Wooden Dr
Martinsville, IN 46151
Phone (765) 342-3364

1949 Hospital Dr
Martinsville, IN 46151
Phone (765) 342-8383

60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500

611 E Douglas Rd
Ste 407
Mishawaka, IN 46545
Phone (574) 335-6500

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232

611 E Douglas Rd
Ste 137
Mishawaka, IN 46545
Phone (574) 335-6214

707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328

1122 S Ironwood Dr
South Bend, IN 46615
Phone (574) 335-8399

Interoperability endpoints

  • Direct secure messaging: nstewart1154414@direct.trinity-health.org

Organizations & group practices 5

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 8

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": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1063773422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12563 STATE RD 23",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309226",
            "telephone_number": "574-335-8300",
            "fax_number": "574-335-0775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1949 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Martinsville",
            "state": "IN",
            "postal_code": "461511861",
            "country_code": "US",
            "telephone_number": "765-342-8383",
            "fax_number": "765-349-8413",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1122 S Ironwood Dr",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "46615",
            "country_code": "US",
            "telephone_number": "574-335-8399",
            "fax_number": "574-335-0786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEWART",
        "first_name": "NATHANIEL",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01073332A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201087310",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

Verify at the official NPI Registry.