Individual provider Active NPI

Richard W Skupski, M.D.

  • Anesthesiology Physician
  • South Bend, IN
National Provider Identifier
1396722989
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
01040026A Issued in IN
Practice address
416 E Monroe St
Suite 200
South Bend, IN 46601-2360
Phone
(574) 232-8119
Fax
(574) 288-0235
NPI assigned
Dec 27, 2005
Last updated
Aug 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 94508 GA
Anesthesiology Physician 207L00000X 01040026A IN Primary

Addresses

Primary practice location

416 E Monroe St
Suite 200
South Bend, IN 46601-2360

Mailing address

416 E Monroe St
Suite 200
South Bend, IN 46601-2360
Phone (574) 232-8119

Other practice location 1

2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Phone (470) 644-1274

Other practice location 2

600 East Blvd
Elkhart, IN 46514-2483
Phone (574) 524-8130

Other identifiers 1

IdentifierTypeStateIssuer
100092350MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rskupski511075@directwellstar.org Health Information Exchange (HIE)

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
I20101108000453 IN Practitioner - Anesthesiology 9638364417 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Wayne State University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Laporte PCGroup PAC ID 3779614508, 15 clinicians
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

1331 State St
La Porte, IN 46350-3112
Phone (219) 326-1234

600 E Blvd
Beacon Medical Group Anesthesia Elk
Elkhart, IN 46514-2483
Phone (574) 524-8130

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01040026AINMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Anesthesia Associates of Laporte PC Anesthesiology CurrentSince Dec 30, 2023 Accepting new patients
Beacon Medical Group Inc Anesthesiology CurrentSince Oct 14, 2024 Accepting new patients
The Metrohealth System Current Accepting new patients
Seymour Indiana Pathologists, Inc Past Accepting new patients
Daniel L French PSC Past Accepting new patients
St. Joseph Valley Anesthesia P.C. Anesthesiology Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

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

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

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

102 E Culver Rd
Knox, IN 46534
Phone (574) 772-1580

1331 State St
Laporte, IN 46350
Phone (219) 326-2415

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

Interoperability endpoints

  • Direct secure messaging: rskupski215408@direct.metrohealth.org

Organizations & group practices 8

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 2

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": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1396722989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 E MONROE ST",
            "address_2": "SUITE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466012360",
            "telephone_number": "574-232-8119",
            "fax_number": "574-288-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E MONROE ST",
            "address_2": "SUITE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466012360",
            "telephone_number": "574-232-8119",
            "fax_number": "574-288-0235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2540 Windy Hill Rd SE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300678605",
            "country_code": "US",
            "telephone_number": "470-644-1274",
            "fax_number": "470-644-1119",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 East Blvd",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142483",
            "country_code": "US",
            "telephone_number": "574-524-8130",
            "fax_number": "574-524-8138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKUPSKI",
        "first_name": "RICHARD",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "94508",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01040026A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092350",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rskupski511075@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2540 Windy Hill Rd SE",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300678605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.