Individual provider Active NPI

Edward J Durbin, MD

  • Obstetrics & Gynecology Physician
  • South Bend, IN
National Provider Identifier
1194715581
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
01044831A Issued in IN
Practice address
714 N Michigan St
South Bend, IN 46601-1035
Phone
(574) 647-7477
Fax
(574) 647-3655
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 01044831A IN Primary

Addresses

Primary practice location

714 N Michigan St
South Bend, IN 46601-1035

Mailing address

3245 Health Drive
Suite 100
Granger, IN 46530-3245
Phone (574) 647-1840

Other practice location 1

621 Memorial Dr
Ste 403
South Bend, IN 46601-1074
Phone (574) 647-1405

Other identifiers 1

IdentifierTypeStateIssuer
200105350MedicaidIN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101026000621 IN Practitioner - Obstetrics/Gynecology 4082701933 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01044831AINMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Obstetrix Medical Group of Indiana, P.C. CurrentSince Feb 15, 2021 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Jan 8, 2013 Accepting new patients
Beacon Medical Group, Inc. Obstetrics & Gynecology CurrentSince Jan 8, 2013 Accepting new patients
Pediatrix Medical Group of Indiana, PC CurrentSince Jan 5, 2023 Accepting new patients
Healthlinc, Inc Past Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

621 Memorial Dr
Ste 402
South Bend, IN 46601
Phone (574) 232-4800

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

621 Memorial Dr
Ste 403
South Bend, IN 46601
Phone (574) 647-1405

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

1708 High St
South Bend, IN 46613
Phone (574) 237-6640

714 N Michigan St
South Bend, IN 46601
Phone (574) 647-7477

100 Navarre Pl
Ste 4470
South Bend, IN 46601
Phone (574) 647-1300

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1194715581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DRIVE",
            "address_2": "SUITE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465303245",
            "telephone_number": "574-647-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011035",
            "telephone_number": "574-647-7477",
            "fax_number": "574-647-3655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "621 Memorial Dr",
            "address_2": "Ste 403",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011074",
            "country_code": "US",
            "telephone_number": "574-647-1405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DURBIN",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01044831A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200105350",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.