NPIMap

Individual provider Active NPI

Michael James Oconnell, DO

  • Family Medicine Physician
  • South Bend, IN
National Provider Identifier
1083691885
Registry record updated Nov 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02000569A Issued in IN
Practice address
17960 Cleveland Rd
South Bend, IN 46635-1349
Phone
(574) 287-7205
Fax
(574) 232-5045
NPI assigned
Dec 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2009

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 02000569A IN Primary

Addresses

Primary practice location

17960 Cleveland Rd
South Bend, IN 46635-1349

Mailing address

17960 Cleveland Rd
South Bend, IN 46635-1349
Phone (574) 287-7205

Other identifiers 1

IdentifierTypeStateIssuer
000000095399OtherINANTHEM BLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100106000651 IN Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 3678465689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

17960 Cleveland Rd
South Bend, IN 46635-1349
Phone (574) 287-7205

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Michael J. O'Connell D.O. Inc Family Medicine CurrentSince Jul 1, 1977 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

17960 Cleveland Rd
South Bend, IN 46635
Phone (574) 272-7212

Organizations & group practices 2

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 9

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": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1083691885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17960 CLEVELAND RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351349",
            "telephone_number": "574-287-7205",
            "fax_number": "574-232-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17960 CLEVELAND RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351349",
            "telephone_number": "574-287-7205",
            "fax_number": "574-232-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OCONNELL",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02000569A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000095399",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.