Individual provider Active NPI

Eduardo Campos-Hernandez, PT

  • Physical Therapist
  • Mishawaka, IN
National Provider Identifier
1073483715
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05016233A Issued in IN
Practice address
202 Lincolnway E Ste 100
Mishawaka, IN 46544-2079
Phone
(574) 647-2560
Fax
(574) 647-2563
NPI assigned
Nov 7, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 05016233A IN
Physical Therapist 225100000X 05016233A IN Primary

Addresses

Primary practice location

202 Lincolnway E Ste 100
Mishawaka, IN 46544-2079

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-3725

Other practice location 1

200 E Jackson Blvd Ste 150
Elkhart, IN 46516-3513
Phone (574) 389-5558

Other practice location 2

3221 Beacon Pkwy Ste 100
Granger, IN 46530-7196
Phone (574) 647-2930

Other practice location 3

111 W Jefferson Blvd Ste 100
South Bend, IN 46601-1993
Phone (574) 647-2600

Other practice location 4

1815 E Ireland Rd Ste 100
South Bend, IN 46614-2845
Phone (574) 647-5790

Other identifiers 1

IdentifierTypeStateIssuer
300124715MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251226000630 IN Practitioner - Physical Therapist in Private Practice 1355837576 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Health LLCGroup PAC ID 1254690530, 32 clinicians

Practice addresses (Care Compare)

1815 E Ireland Rd
Suite 100
South Bend, IN 46614-2845
Phone (574) 647-5790

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05016233AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Health, LLC Physical Therapist CurrentSince Jan 25, 2026 Accepting new patients
Beacon Medical Group, Inc. PastSince Jan 25, 2026 Accepting new patients
Beacon Health, LLC Past Accepting new patients

Locations

200 E Jackson Blvd
Ste 150
Elkhart, IN 46516
Phone (574) 389-5558

3221 Beacon Pkwy
Ste 100
Granger, IN 46530
Phone (574) 647-2930

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

202 Lincolnway E
Ste 100
Mishawaka, IN 46544
Phone (574) 647-2560

1815 E Ireland Rd
#100
South Bend, IN 46614
Phone (574) 647-5790

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": "1762473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773964800000",
    "number": "1073483715",
    "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": "574-647-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 LINCOLNWAY E STE 100",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442079",
            "telephone_number": "574-647-2560",
            "fax_number": "574-647-2563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E JACKSON BLVD STE 150",
            "address_purpose": "LOCATION",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465163513",
            "country_code": "US",
            "telephone_number": "574-389-5558",
            "fax_number": "574-389-5559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3221 Beacon Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465307196",
            "country_code": "US",
            "telephone_number": "574-647-2930",
            "fax_number": "574-647-2935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 W Jefferson Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011993",
            "country_code": "US",
            "telephone_number": "574-647-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1815 E Ireland Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-5790",
            "fax_number": "574-647-5792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPOS-HERNANDEZ",
        "first_name": "EDUARDO",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-07",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IN",
            "license": "05016233A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05016233A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300124715",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; 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.