Individual provider Active NPI

Megan Elizabeth Conway, M.D.

  • Pediatric Critical Care Medicine Physician
  • South Bend, IN
National Provider Identifier
1063895845
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
4301500382 Issued in MI
Practice address
615 N Michigan St
5TH FL
South Bend, IN 46601-1033
Phone
(574) 647-7275
Fax
(574) 647-3696
NPI assigned
Jun 30, 2015
Last updated
Apr 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301500382 MI
Pediatric Critical Care Medicine Physician 2080P0203X 4301500382 MI Primary

Addresses

Primary practice location

615 N Michigan St
5TH FL
South Bend, IN 46601-1033

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-2129

Other identifiers 1

IdentifierTypeStateIssuer
300068660MedicaidIN

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
I20221109000296 IN Practitioner - Pediatric Medicine 2961708250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Michigan State University College of Human Medicine, 2015
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)

615 N Michigan St
FL 5
South Bend, IN 46601-1033
Phone (574) 647-7275

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301500382MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Oct 31, 2022 Accepting new patients
Beacon Medical Group, Inc. Pediatric Critical Care Medicine CurrentSince Oct 31, 2022 Accepting new patients

Locations

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

100 Navarre Pl
Ste 5550
South Bend, IN 46601
Phone (574) 234-5123

615 N Michigan St
Fl 5
South Bend, IN 46601
Phone (574) 647-7275

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1063895845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "telephone_number": "574-647-2129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "address_2": "5TH FL",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-7275",
            "fax_number": "574-647-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONWAY",
        "first_name": "MEGAN",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301500382",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MI",
            "license": "4301500382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300068660",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.