Individual provider Active NPI

Emilee Tehrani, NP-C, RN

  • Family Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1073042024
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71007235A Issued in IN
Practice address
621 Memorial Dr Ste 512
South Bend, IN 46601-1075
Phone
(574) 246-9350
NPI assigned
Jun 5, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71007235A IN Primary

Addresses

Primary practice location

621 Memorial Dr Ste 512
South Bend, IN 46601-1075

Mailing address

621 Memorial Drive
512
South Bend, IN 46601
Phone (574) 246-9350

Other identifiers 1

IdentifierTypeStateIssuer
300068900MedicaidIN

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
I20180622000969 IN Practitioner - Nurse Practitioner 2466707047 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)

621 Memorial Dr
South Bend, IN 46601-1073

6913 N Main St
Granger, IN 46530-8039

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71007235AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. CurrentSince Oct 1, 2022 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Oct 1, 2022 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

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

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

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

621 Memorial Dr
Ste 512
South Bend, IN 46601
Phone (574) 246-9350

Interoperability endpoints

  • Direct secure messaging: etehrani1147656@direct.trinity-health.org

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 6

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": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1073042024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DRIVE",
            "address_2": "512",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46601",
            "telephone_number": "574-246-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 512",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011075",
            "telephone_number": "574-246-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEHRANI",
        "first_name": "EMILEE",
        "credential": "NP-C, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-05",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007235A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300068900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.