Shane Michael Ditty, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

01060795 Issued in IN

Practice address

416 E Monroe St
Ste. 200
South Bend, IN 46601-2371

Phone

(574) 232-8119

Fax

(574) 288-0235

NPI assigned

May 7, 2007

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

Other identifiers 2

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

Anesthesiology

Education

Indiana University School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Anesthesiologists IncGroup PAC ID 6800837980, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southeast Anesthesiologists, Inc.

  • Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1548210685

  Anesthesiology, IN

  Medicare reassignment Care Compare group NPD
• Southside Emergency Associates

  • Personal Emergency Response Attendant
  • Indianapolis, IN
  • NPI 1053366922
  NPD (past)

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

• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093

  Hospital

  Care Compare affiliation
• Memorial Hospital of South Bend

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395

  Hospital

  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223251200000",
    "number": "1104039288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 E MONROE ST",
            "address_2": "STE. 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466012371",
            "telephone_number": "574-232-8119",
            "fax_number": "574-288-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E MONROE ST",
            "address_2": "STE. 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466012371",
            "telephone_number": "574-232-8119",
            "fax_number": "574-288-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITTY",
        "first_name": "SHANE",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2008-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01060795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200859480",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "236080EE",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heaven Dietz, RBT
• Tyler Eric Dietzel, MD
• Anamilena Dillon
• Sarah Dillon, MSW, LSW
• Jonathan Edwards Ditty, M.D.
• Divine Favor LLC
• Divine Interventions Inc.
• Marie Kathleen Dix, MD
• Marquette Dixon, MA
• Shauntae Marie Dixon

• All providers in South Bend, IN
• Anesthesiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2008; 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.