Active NPI
Tamara Ann McNally, CNM
- Advanced Practice Midwife
- Mishawaka, IN
National Provider Identifier
1275570129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 72000001A
- Practice address
- 420 W 4TH St
Mishawaka, IN 46544-1948 - Phone
- (574) 252-0304
- NPI assigned
- Jun 1, 2006
- Last updated
- Jun 11, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 72000001A | IN | Primary |
Addresses
Primary practice location
420 W 4TH St
Mishawaka, IN 46544-1948
Mailing address
PO Box 6489
South Bend, IN 46660-6489
Phone (574) 472-6700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000578093 | Other | IN | BLUE CROSS |
| 100466420 | Medicaid | IN | |
| 11479732 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72000001A | IN | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Community Hospital of Mishawaka | Past | Accepting new patients | |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Healthy Family Center
- Multi-Specialty Clinic/Center
- Mishawaka, IN
- NPI 1235202573
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1841245594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244678400000",
"number": "1275570129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6489",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466606489",
"telephone_number": "574-472-6700",
"fax_number": "574-472-6746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W 4TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441948",
"telephone_number": "574-252-0304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNALLY",
"first_name": "TAMARA",
"middle_name": "ANN",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-01",
"last_updated": "2009-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "IN",
"license": "72000001A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "000000578093",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100466420",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11479732",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.