Individual provider Active NPI

Anne K. Gruber, PA-C

  • Medical Physician Assistant
  • Elkhart, IN
National Provider Identifier
1255884581
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10001997A Issued in IN
Practice address
3301 County Road 6 E
Elkhart, IN 46514-7673
Phone
(574) 266-5342
Fax
(574) 266-5847
NPI assigned
Aug 3, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 10001997A IN Primary

Addresses

Primary practice location

3301 County Road 6 E
Elkhart, IN 46514-7673

Mailing address

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

Other practice location 1

6913 N Main St
Granger, IN 46530-8039
Phone (574) 647-1500

Other practice location 2

2222 Rieth Blvd
Suite 100
Goshen, IN 46526-5869
Phone (574) 875-1200

Other practice location 3

1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1750

Other practice location 4

206 W Warren St
Middlebury, IN 46540-9410
Phone (574) 237-9200

Other identifiers 1

IdentifierTypeStateIssuer
300067450MedicaidIN

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
I20220926002129 IN Practitioner - Physician Assistant 4082090212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
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)

1815 E Ireland Rd
South Bend, IN 46614-2845

206 W Warren St
Middlebury, IN 46540-9410

2222 Rieth Blvd
Goshen, IN 46526-5869

6913 N Main St
Granger, IN 46530-8039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. CurrentSince Sep 18, 2022 Accepting new patients
Beacon Medical Group Inc CurrentSince Sep 18, 2022 Accepting new patients
Beacon Occupational Health, LLC PastSince Aug 1, 2022 Accepting new patients

Locations

3301 County Road 6 E
Elkhart, IN 46514
Phone (574) 264-9635

2222 Rieth Blvd
Ste 100
Goshen, IN 46526
Phone (574) 875-1200

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

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

900 I St
Laporte, IN 46350
Phone (219) 324-1670

206 W Warren St
Middlebury, IN 46540
Phone (219) 825-2146

1815 E Ireland Rd
South Bend, IN 46614
Phone (574) 647-1700

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.

NPI Registry JSON

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1255884581",
    "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": "3301 COUNTY ROAD 6 E",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465147673",
            "telephone_number": "574-266-5342",
            "fax_number": "574-266-5847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6913 N Main St",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308039",
            "country_code": "US",
            "telephone_number": "574-647-1500",
            "fax_number": "574-243-4306",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 Rieth Blvd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465265869",
            "country_code": "US",
            "telephone_number": "574-875-1200",
            "fax_number": "574-875-0362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1815 E Ireland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-1750",
            "fax_number": "574-647-1748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "206 W Warren St",
            "address_purpose": "LOCATION",
            "city": "Middlebury",
            "state": "IN",
            "postal_code": "465409410",
            "country_code": "US",
            "telephone_number": "574-237-9200",
            "fax_number": "574-358-0157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRUBER",
        "first_name": "ANNE",
        "middle_name": "K.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10001997A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300067450",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.