Dyllan Tiburzi

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01085663A Issued in IN

Practice address

2235 Cleveland Rd
South Bend, IN 46628-3529

Phone

(574) 647-4530

Fax

(574) 647-2285

NPI assigned

Apr 27, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Family Practice

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2018

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)

Hospital & facility affiliations

• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617
  Medicare reassignment Care Compare group NPD
• Beacon Medical Group Inc

  • Anesthesiology Physician
  • Elkhart, IN
  • NPI 1437803285
  NPD
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1588024624
  NPD
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1609828946
  NPD
• Beacon Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • South Bend, IN
  • NPI 1831149525
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  Care Compare affiliation
• Memorial Hospital of South Bend

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395
  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1326536095",
    "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": "2235 CLEVELAND RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466283529",
            "telephone_number": "574-647-4530",
            "fax_number": "574-647-2285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "714 N Michigan St",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011035",
            "country_code": "US",
            "telephone_number": "574-647-7477",
            "fax_number": "574-647-3655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIBURZI",
        "first_name": "DYLLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-27",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01085663A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300014050",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dtiburzi@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "714 N Michigan St",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.