Sandra R. Brown, M.D.
Individual provider Active NPI Gynecology Physician · Bremen, IN
NPI 1194764449 · NPPES record last updated Jun 25, 2024
Key facts
- NPI
- 1194764449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gynecology Physician 207VG0400X
- License
- 01027735A (IN)
- Practice address
- 1144 W Plymouth St
Bremen, IN 46506-1842 - Phone
- (574) 546-5363
- Fax
- (574) 546-2575
- NPI assigned
- Jun 5, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091217000124 | IN | Practitioner - Obstetrics/Gynecology | 9931249208 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01027735A | IN | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group, Inc. | Current | Accepting new patients | |
| Beacon Medical Group Inc | Current |
Accepting new patients | |
| Beacon Medical Group Inc | Gynecology | Current |
Accepting new patients |
Locations
1144 W Plymouth St
Bremen, IN 46506
Phone (574) 546-5363
6913 N Main St
Granger, IN 46530
Phone (574) 647-1500
3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129
621 Memorial Dr
Ste 302
South Bend, IN 46601
Phone (574) 236-1888
710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610
100 Navarre Pl
Ste 4470
South Bend, IN 46601
Phone (574) 647-1300
615 N Michigan St
Fl 1
South Bend, IN 46601
Phone (574) 647-1100
Interoperability endpoints
- srbrown@mybeacon.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 01027735A | IN | |
| Gynecology Physician | 207VG0400X | 01027735A | IN | Yes |
Addresses
Primary practice location
1144 W Plymouth St
Bremen, IN 46506-1842
Mailing address
3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-2129
Other practice location 1
621 Memorial Dr Ste 302
South Bend, IN 46601-1073
Phone (574) 367-3800
Other practice location 2
100 Navarre Pl Ste 4470
South Bend, IN 46601-1168
Phone (574) 367-3800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100338010 | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | srbrown@mybeacon.cernerdirect.com |
Other providers in Bremen, IN
- Beacon Medical Group, Inc.
- Kara Beebe
- Laura A Both
- Bremen Chiropractic Center PC
- Bremen Public Schools
- Sharlotte Brown
- Gregory Edward Buck
- Cardinal Center, Inc.
- Cardinal Center, Inc.
- Community Family Physicians, PC
All providers in Bremen, IN · Gynecology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.