Active NPI
United Surgeons, LLC
- Anesthesiology Physician
- Mishawaka, IN
National Provider Identifier
1376148593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- Legal business name
- UNITED SURGEONS, LLC
- Practice address
- 4455 Edison Lakes Pkwy
Mishawaka, IN 46545-1414 - Phone
- (574) 231-6800
- Fax
- (574) 231-6845
- NPI assigned
- Dec 4, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kelly Macken-Marble
- Title
- Ceo
- Phone
- (574) 231-6800
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | Primary | ||
| Certified Registered Nurse Anesthetist | 367500000X |
Addresses
Primary practice location
4455 Edison Lakes Pkwy
Mishawaka, IN 46545-1414
Mailing address
4455 Edison Lakes Pkwy
Mishawaka, IN 46545-1414
Phone (574) 231-6800
Other names 1
- Unity Physicians Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110330000083 | IN | Part B Supplier - Clinic/Group Practice | 0941260061 |
Receives reassigned benefits from 51 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mishawaka, IN |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607040000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607558400000",
"number": "1376148593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4455 EDISON LAKES PKWY",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451414",
"telephone_number": "574-231-6800",
"fax_number": "574-231-6845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4455 EDISON LAKES PKWY",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451414",
"telephone_number": "574-231-6800",
"fax_number": "574-231-6845"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNITED SURGEONS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-12-04",
"last_updated": "2020-12-10",
"certification_date": "2020-12-10",
"status": "A",
"authorized_official_last_name": "MACKEN-MARBLE",
"authorized_official_first_name": "KELLY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "574-231-6800"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Anesthesiology",
"state": null,
"license": null,
"primary": true
},
{
"code": "367500000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Unity Physicians Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.