The South Bend Clinic LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

THE SOUTH BEND CLINIC LLC

Practice address

301 E Day Rd
Mishawaka, IN 46545-3455

Phone

(574) 299-2450

NPI assigned

Jul 30, 2021

Last updated

Nov 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Lynn Hiler

Title

Credentialing Coordinator

Phone

(574) 239-1567

Specialties & licenses 1

Addresses

Other names 1

• The South Bend Clinic Day Road Other name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• The South Bend Clinic LLC

  • Clinic/Center
  • South Bend, IN
  • NPI 1073680419

  3779577937

  Same PAC ID

Tax ID family

South Bend Clinic LLP9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

• Family Care Associates

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1225019219
  NPD tax ID
• The South Bend Clinic LLC

  dba The South Bend Clinic Pharmacy at Granger

  • Clinic Pharmacy
  • Granger, IN
  • NPI 1174187553
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1538832910
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1891468278
  NPD tax ID
• The South Bend Clinic LLP

  dba The South Bend Clinic Laboratory

  • Clinical Medical Laboratory
  • South Bend, IN
  • NPI 1528659216
  NPD tax ID
• The South Bend Clinic LLP

  • Clinic/Center
  • South Bend, IN
  • NPI 1538257167
  NPD tax ID
• The South Bend Clinic Pharmacy

  • Pharmacist
  • South Bend, IN
  • NPI 1144357328
  NPD tax ID
• The South Bend Clinic, LLC

  • Anesthesiology Physician
  • South Bend, IN
  • NPI 1487307492
  NPD tax ID

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1124791587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E DAY RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453455",
            "telephone_number": "574-259-9668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E DAY RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453455",
            "telephone_number": "574-299-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH BEND CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-30",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "HILER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "574-239-1567"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The South Bend Clinic Day Road",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "The South Bend Clinic Day Road",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• The Lasik Vision Insitute LLC
• Brittney Lynn Thibault
• Anita Marie Thomas, PHARMD
• Bryon Wesley Thomas, M.D.
• Jill Thomas
• Katelyn L Thomas

• Durable Medical Equipment & Medical Supplies in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.