Individual provider Active NPI

Cody Lane Ward, MD

  • Sports Medicine (Family Medicine) Physician
  • South Bend, IN
National Provider Identifier
1316501257
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
01088698A Issued in IN
Practice address
111 W Jefferson Blvd Ste 100
South Bend, IN 46601-1993
Phone
(574) 647-1670
Fax
(574) 647-6927
NPI assigned
Apr 25, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01088698A IN
Sports Medicine (Family Medicine) Physician 207QS0010X 01088698A IN Primary

Addresses

Primary practice location

111 W Jefferson Blvd Ste 100
South Bend, IN 46601-1993

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-2129

Other practice location 1

1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1700

Other practice location 2

3221 Beacon Pkwy
Granger, IN 46530-7196
Phone (574) 647-1670

Other practice location 3

100 Navarre Pl Ste 4440
South Bend, IN 46601-1171
Phone (574) 647-5300

Other identifiers 1

IdentifierTypeStateIssuer
300026726MedicaidIN

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
I20230712004530 IN Practitioner - Family Practice 6103150594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2019
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)

111 W Jefferson Blvd
100 Beacon Bone and Joint Specialists
South Bend, IN 46601-1993
Phone (574) 647-1670

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01088698AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Beacon Medical Group Inc CurrentSince Aug 29, 2023 Accepting new patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Beacon Medical Group, Inc. Family Medicine CurrentSince Aug 29, 2023 Accepting new patients

Locations

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

3221 Beacon Pkwy
Granger, IN 46530
Phone (574) 647-1670

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

615 N Michigan St
Fl 1
South Bend, IN 46601
Phone (574) 647-1100

111 W Jefferson Blvd
Ste 100
South Bend, IN 46601
Phone (574) 647-1669

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

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

100 Navarre Pl
Ste 4440
South Bend, IN 46601
Phone (574) 647-4540

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 5

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": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1316501257",
    "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": "574-647-2129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W JEFFERSON BLVD STE 100",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011993",
            "telephone_number": "574-647-1670",
            "fax_number": "574-647-6927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E Ireland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-1700",
            "fax_number": "574-647-7572",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3221 Beacon Pkwy",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465307196",
            "country_code": "US",
            "telephone_number": "574-647-1670",
            "fax_number": "574-647-6927",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Navarre Pl Ste 4440",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011171",
            "country_code": "US",
            "telephone_number": "574-647-5300",
            "fax_number": "574-647-5305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARD",
        "first_name": "CODY",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-25",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01088698A",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IN",
            "license": "01088698A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300026726",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.