Individual provider Active NPI

Leslie Nicole Kaniuk, NP

  • Family Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1245065127
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71016046A Issued in IN
Practice address
100 Navarre PL Ste 4400
South Bend, IN 46601-1100
Phone
(574) 647-2501
Fax
(574) 647-2506
NPI assigned
Sep 3, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71016046A IN Primary

Addresses

Primary practice location

100 Navarre PL Ste 4400
South Bend, IN 46601-1100

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-6592

Other practice location 1

5314 Lincolnway E
Mishawaka, IN 46544-4249
Phone (574) 647-8542

Other identifiers 1

IdentifierTypeStateIssuer
300101596MedicaidIN

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250121001626 IN Practitioner - Nurse Practitioner 1557890571 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

2235 Cleveland Rd
South Bend, IN 46628-3529
Phone (574) 647-4530

Hospital & facility affiliations

  • Elara Caring Home health agency, Kokomo, IN, CCN 157586
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71016046AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Feb 9, 2025 Accepting new patients
Beacon Medical Group, Inc. Family CurrentSince Feb 9, 2025 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

6913 N Main St
Ste 100
Granger, IN 46530
Phone (574) 647-6400

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

5314 Lincolnway E
Mishawaka, IN 46544
Phone (574) 256-9032

2235 Cleveland Rd
South Bend, IN 46628
Phone (574) 647-4530

100 Navarre Pl
Ste 6600
South Bend, IN 46601
Phone (574) 232-7227

100 Navarre Pl
Ste 4400
South Bend, IN 46601
Phone (574) 647-2501

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1245065127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "telephone_number": "574-647-6592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 4400",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011100",
            "telephone_number": "574-647-2501",
            "fax_number": "574-647-2506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5314 Lincolnway E",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465444249",
            "country_code": "US",
            "telephone_number": "574-647-8542",
            "fax_number": "574-647-8549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANIUK",
        "first_name": "LESLIE",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-03",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71016046A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300101596",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.