Gregg M Ebersole, M.D.
Individual provider Active NPI Orthopaedic Surgery Physician · South Bend, IN
NPI 1093000366 · NPPES record last updated Apr 1, 2021
Key facts
- NPI
- 1093000366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 01079875A (IN)
- Practice address
- 100 Navarre PL Ste 4440
South Bend, IN 46601-1171 - Phone
- (574) 647-5300
- Fax
- (574) 647-5305
- NPI assigned
- Jun 15, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Beacon Medical Group Inc
Practice addresses (Care Compare)
100 Navarre PL
5500 BMG Interventional Radiology
South Bend, IN 46601-1172
Phone (574) 647-5200
Hospital & facility affiliations
- Elara Caring
- Memorial Hospital of South Bend
- Saint Joseph Regional Medical Center
- Northwest Health-la Porte
- Lakeland Hospital, St Joseph
- Elkhart General Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 56 |
| Knee replacement | 42 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180501000540 | IN | Practitioner - Orthopedic Surgery | 7416259940 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01079875A | IN | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group, Inc. | Current | Accepting new patients | |
| Beacon Medical Group, Inc. | Current | Accepting new patients | |
| Beacon Medical Group, Inc. | Current |
Accepting new patients | |
| Beacon Medical Group Inc | Current |
Accepting new patients | |
| Beacon Medical Group, Inc. | Current | Accepting new patients | |
| Beacon Medical Group, Inc. | Orthopaedic Surgery | Past | Accepting new patients |
Locations
3221 Beacon Pkwy
Granger, IN 46530
Phone (574) 647-1670
6913 N Main St
Granger, IN 46530
Phone (574) 647-1500
900 I St
Laporte, IN 46350
Phone (219) 324-1670
615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000
615 N Michigan St
Fl 1
South Bend, IN 46601
Phone (574) 647-1100
100 Navarre Pl
Ste 5500
South Bend, IN 46601
Phone (574) 647-5200
1815 E Ireland Rd
South Bend, IN 46614
Phone (574) 647-1700
2235 Cleveland Rd
South Bend, IN 46628
Phone (574) 647-4530
100 Navarre Pl
Ste 4440
South Bend, IN 46601
Phone (574) 647-4540
710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610
Interoperability endpoints
- gebersole@mybeacon.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 01079875A | IN | Yes |
Addresses
Primary practice location
100 Navarre PL Ste 4440
South Bend, IN 46601-1171
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other practice location 1
3221 Beacon Pkwy
Granger, IN 46530-7196
Phone (574) 647-1670
Other practice location 2
1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1700
Other practice location 3
900 I St
LA Porte, IN 46350-5533
Phone (219) 324-1700
Other practice location 4
2235 Cleveland Rd
South Bend, IN 46628-3529
Phone (574) 647-4530
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300013151 | Medicaid | IN | |
| 261970087 | Other | IN | MEDICARE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gebersole@mybeacon.cernerdirect.com |
Other providers in South Bend, IN
- Elizabeth A Early
- Jonathan Andrew Eash
- Lauren Elizabeth Eastwood
- Ellen Jean Eaton
- Kelly Eberhart
- Edison Lakes Oral Surgery, P.C.
- Andrea R Edmister
- Morgan Nicole Edmonds
- Mallory Edmondson
- Daniela M Edson
All providers in South Bend, IN · Orthopaedic Surgery Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.