Gregg M Ebersole, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

01079875A Issued in 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

Last updated

Apr 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Orthopedic Surgery

Education

Other, 2011

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)

Hospital & facility affiliations

• Elara Caring Home health agency, Kokomo, IN, CCN 157586
• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
• Northwest Health-la Porte Hospital, La Porte, IN, CCN 150006
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gebersole@mybeacon.cernerdirect.com

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.

• Beacon Medical Group, Inc.

  dba Beacon Medical Group Schwartz - Wiekamp

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617
  Medicare reassignment Care Compare group NPD
• Beacon Medical Group Inc

  dba Beacon Medical Group Anesthesia Elkhart

  • Anesthesiology Physician
  • Elkhart, IN
  • NPI 1437803285
  NPD
• Beacon Medical Group, Inc.

  dba Beacon Medical Group Main Street

  • Family Medicine Physician
  • Granger, IN
  • NPI 1053361543
  NPD
• Beacon Medical Group, Inc.

  dba Beacon Medical Group Ireland Road

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1124079330
  NPD
• Beacon Medical Group, Inc.

  dba Beacon Medical Group Cleveland Road

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1588024624
  NPD
• Beacon Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • South Bend, IN
  • NPI 1831149525
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Home Health Network of Indiana, LLC

  dba Elara Caring

  • Home Health Agency
  • Kokomo, IN
  • NPI 1346255940
  Care Compare affiliation
• Elkhart General Hospital, Inc.

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1477551489
  Care Compare affiliation
• La Porte Hospital Company LLC

  dba Northwest Health-La Porte

  • General Acute Care Hospital
  • La Porte, IN
  • NPI 1750746285
  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Memorial Epworth Center

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Beacon Granger Hospital, A Memorial Hospital Extension

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1093000366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 4440",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011171",
            "telephone_number": "574-647-5300",
            "fax_number": "574-647-5305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3221 Beacon Pkwy",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465307196",
            "country_code": "US",
            "telephone_number": "574-647-1670",
            "fax_number": "574-647-6927",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1815 E Ireland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-1700",
            "fax_number": "574-647-7572",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 I St",
            "address_purpose": "LOCATION",
            "city": "LA Porte",
            "state": "IN",
            "postal_code": "463505533",
            "country_code": "US",
            "telephone_number": "219-324-1700",
            "fax_number": "219-324-1602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2235 Cleveland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466283529",
            "country_code": "US",
            "telephone_number": "574-647-4530",
            "fax_number": "574-647-2285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "GREGG",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-15",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "01079875A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gebersole@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "3221 Beacon Pkwy",
            "city": "Granger",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465307196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth A Early, CCC/SLP
• Jonathan Andrew Eash, M.D.
• Lauren Elizabeth Eastwood
• Ellen Jean Eaton, OTR
• Kelly Eberhart
• Edison Lakes Oral Surgery, P.C. (Oral Surgery Michiana)
• Andrea R Edmister, AUD
• Morgan Nicole Edmonds, AGPCNP-BC
• Mallory Edmondson, MSDH, RDH
• Daniela M Edson, AGACNP, NP

• Orthopaedic Surgery Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Orthopaedic Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.