Memorial Health System, Inc.

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

01060385A Issued in IN

Legal business name

MEMORIAL HEALTH SYSTEM, INC.

Doing business as

Developmental Pediatrics

Practice address

809 N Michigan St
South Bend, IN 46601-1088

Phone

(574) 647-7300

NPI assigned

May 11, 2006

Last updated

Mar 9, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Costello

Title

VP-Cfo

Phone

(574) 647-3549

Specialties & licenses 1

Addresses

Other names 1

• Developmental Pediatrics Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William Lawrence Mize, M.D.

  • Pediatrics Physician
  • Galveston, TX
  • NPI 1790776326
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1346290103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011088",
            "telephone_number": "574-647-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VP-CFO",
        "authorized_official_telephone_number": "574-647-3549"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "IN",
            "license": "01060385A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Developmental Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sejal Mehta
• Meijer Stores Limited Partnership (Meijer Pharmacy #120)
• Britany Melton, BCBA
• Ian Melton, BCBA
• Memorial Health System, Inc. (Heart Specialists PC)
• Memorial Health System, Inc. (Memorial's Prenatal Clinic @ Olive Street)
• Memorial Home Care, Inc.
• Memorial Home Care, Inc.
• Memorial Home Care, Inc.
• Memorial Hospital

• Developmental - Behavioral Pediatrics Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Developmental - Behavioral Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.