NPIMap

Individual provider Active NPI

Shelley A. Morris, D.O.

  • Family Medicine Physician
  • Granger, IN
National Provider Identifier
1376737387
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02003725A Issued in IN
Practice address
12340 Bittersweet Commons Blvd W
Granger, IN 46530-6959
Phone
(574) 271-8610
Fax
(574) 271-8620
NPI assigned
Sep 3, 2007
Last updated
Mar 31, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02003725A IN Primary

Addresses

Primary practice location

12340 Bittersweet Commons Blvd W
Granger, IN 46530-6959

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 2

IdentifierTypeStateIssuer
200994220MedicaidIN
236040021OtherINMEDICARE PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MORRIS@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101014000481 IN Practitioner - Family Practice 5799977344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Osteopathy, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

12340 Bittersweet Commons Blvd W
Beacon Medical Group Bittersweet
Granger, IN 46530-6959
Phone (574) 271-8610

600 E Blvd
Elkhart, IN 46514-2483

600 E Blvd 4TH FL Hospitalists
BMG Hospital Specialties
Elkhart, IN 46514-2483
Phone (574) 647-3050

6913 N Main St
Granger, IN 46530-8039

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003725AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Family Medicine CurrentSince Jan 1, 2014 Accepting new patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Beacon Medical Group Inc CurrentSince Jan 1, 2014 Accepting new patients
Elkhart General Hospital, Inc. Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621

12340 Bittersweet Commons Blvd W
Granger, IN 46530
Phone (574) 271-8610

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

Interoperability endpoints

  • Direct secure messaging: morris@mybeacon.cernerdirect.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1188777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1376737387",
    "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",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12340 BITTERSWEET COMMONS BLVD W",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465306959",
            "telephone_number": "574-271-8610",
            "fax_number": "574-271-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORRIS",
        "first_name": "SHELLEY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-03",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003725A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200994220",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "236040021",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MORRIS@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "12340 Bittersweet Commons Blvd W",
            "city": "Granger",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465306959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

Verify at the official NPI Registry.