Active NPI
Richard W Skupski, M.D.
- Anesthesiology Physician
- South Bend, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 01040026A
- 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, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100092350 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
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
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 100
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 01040026A | IN | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group, Inc. | Current | Accepting new patients | |
| Anesthesia Associates of Laporte PC | Anesthesiology | Current | Accepting new patients |
| Beacon Medical Group Inc | Anesthesiology | Current | 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
- 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.
-
- Anesthesiology Physician
- La Porte, IN
- NPI 1235455429
-
dba Beacon Medical Group Schwartz - Wiekamp
- Family Medicine Physician
- Mishawaka, IN
- NPI 1033161617
-
dba Beacon Medical Group Anesthesia Elkhart
- Anesthesiology Physician
- Elkhart, IN
- NPI 1437803285
-
dba Metrohealth Medical Center
- General Acute Care Hospital
- Cleveland, OH
- NPI 1700828852
-
- Orthopaedic Surgery Physician
- South Bend, IN
- NPI 1831149525
-
- Anatomic Pathology & Clinical Pathology Physician
- Seymour, IN
- NPI 1124237987
-
- Anesthesiology Physician
- Mishawaka, IN
- NPI 1790738854
-
- Family Medicine Physician
- Florence, KY
- NPI 1255337952
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Elkhart, IN
- NPI 1477551489
-
dba Northwest Health-La Porte
- General Acute Care Hospital
- La Porte, IN
- NPI 1750746285
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.