Individual provider Active NPI

Emily Heasley, M.D.

  • Obstetrics & Gynecology Physician
  • South Bend, IN
National Provider Identifier
1295174530
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
01078476A Issued in IN
Practice address
211 N Eddy St
South Bend, IN 46617-3096
Phone
(574) 234-8161
NPI assigned
Jun 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 01078476A IN Primary

Addresses

Primary practice location

211 N Eddy St
South Bend, IN 46617-3096

Mailing address

211 N Eddy St
South Bend, IN 46617-3096
Phone (574) 234-8161

Other names 1

  • Emily Starrick Former name

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
I20170614000266 IN Practitioner - Obstetrics/Gynecology 4688806276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Indiana University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

14950 State Rd
Suite 23
Granger, IN 46530-7564
Phone (574) 234-8161

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01078476AINMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic LLC CurrentSince Aug 1, 2017 Accepting new patients
The South Bend Clinic, LLC CurrentSince Aug 1, 2017 Accepting new patients

Locations

14950 State Road 23
Granger, IN 46530
Phone (574) 243-2221

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

6301 University Commons
Ste 310
South Bend, IN 46635
Phone (574) 232-1471

714 N Michigan St
South Bend, IN 46601
Phone (574) 647-7477

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

Interoperability endpoints

  • Direct secure messaging: eheasley1263833@direct.trinity-health.org
  • Direct secure messaging: eheasley256598@dulyhealthandcare.direct-ci.com
  • FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1295174530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173096",
            "telephone_number": "574-234-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173096",
            "telephone_number": "574-234-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEASLEY",
        "first_name": "EMILY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-20",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01078476A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "STARRICK",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.