Individual provider Active NPI

Rajalakshmy Sundararajan, MD

  • Internal Medicine Physician
  • South Bend, IN
National Provider Identifier
1275610529
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01043805A Issued in IN
Practice address
615 N Michigan St
South Bend, IN 46601-1033
Phone
(574) 647-7459
Fax
(574) 647-3658
NPI assigned
Nov 1, 2006
Last updated
Sep 8, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01043805A IN
Internal Medicine Physician 207R00000X 01043805A IN Primary

Addresses

Primary practice location

615 N Michigan St
South Bend, IN 46601-1033

Mailing address

3355 Douglas Rd
Suite 300
South Bend, IN 46635-1781

Other identifiers 2

IdentifierTypeStateIssuer
4455706MedicaidMI
200072630MedicaidIN

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
I20111121000013 IN Practitioner - Internal MedicinePractitioner - Family PracticePractitioner - Emergency Medicine 9436323961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Bend Emergency Physicians IncGroup PAC ID 0941282354, 51 clinicians

Practice addresses (Care Compare)

615 N Michigan St
South Bend, IN 46601-1033
Phone (574) 647-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01043805AINMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Bend Emergency Physicians, Inc Emergency Medicine CurrentSince Jan 1, 2019 Accepting new patients

Locations

1020 High Rd
Bremen, IN 46506
Phone (574) 309-9967

3220 Beacon Pkwy
Granger, IN 46530
Phone (574) 647-8788

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

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1275610529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 DOUGLAS RD",
            "address_2": "SUITE 300",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-7459",
            "fax_number": "574-647-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARARAJAN",
        "first_name": "RAJALAKSHMY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01043805A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01043805A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4455706",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200072630",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.