Active NPI
Jack S. Bartoszek, D.O.
- Geriatric Medicine (Family Medicine) Physician
- Mishawaka, IN
National Provider Identifier
1093714818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- 02001105
- Practice address
- 615 Fulmer Rd
Mishawaka, IN 46544-6911 - Phone
- (574) 252-3085
- Fax
- (574) 252-5906
- NPI assigned
- Jul 14, 2005
- Last updated
- Sep 20, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 02001105 | IN | Primary |
Addresses
Primary practice location
615 Fulmer Rd
Mishawaka, IN 46544-6911
Mailing address
4455 Edison Lakes Pkwy
Unity Medical Surgical Hospital
Mishawaka, IN 46545-1442
Phone (574) 252-3085
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100335800A | Medicaid | IN | |
| OA41009 | Other | MI | BCBSM |
| 000000109340 | Other | IN | ANTHEM NUMBER |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200401003246 | IN | Order and Referring Only - Family Practice | 8527019132 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Interoperability endpoints
- https://api.platform.athenahealth.com/13629/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379635200000",
"number": "1093714818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4455 EDISON LAKES PKWY",
"address_2": "UNITY MEDICAL SURGICAL HOSPITAL",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451442",
"telephone_number": "574-252-3085",
"fax_number": "574-252-5906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 FULMER RD",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465446911",
"telephone_number": "574-252-3085",
"fax_number": "574-252-5906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARTOSZEK",
"first_name": "JACK",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2013-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "IN",
"license": "02001105",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100335800A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "OA41009",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM NUMBER",
"identifier": "000000109340",
"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 Sep 20, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.