South Bend in Endoscopy ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

17-009761-1 Issued in IN

Legal business name

SOUTH BEND IN ENDOSCOPY ASC LLC

Doing business as

Michiana Endoscopy Center

Practice address

53830 Generations Dr
South Bend, IN 46635-1557

Phone

(574) 271-0893

Fax

(574) 271-4362

NPI assigned

May 31, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Snodgrass

Title

President

Phone

(615) 665-1283

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Michiana Endoscopy Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Michiana Endoscopy CenterCCN 15C0001071

Medicare certification status

ActiveFrom the Provider of Services file

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1427051796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD",
            "address_2": "ATTN: L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156103",
            "telephone_number": "574-271-0893",
            "fax_number": "574-271-4362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53830 GENERATIONS DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351557",
            "telephone_number": "574-271-0893",
            "fax_number": "574-271-4362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEND IN ENDOSCOPY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "17-009761-1",
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "IN",
            "license": "010076",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200156540",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INDIANA",
            "identifier": "000000098200",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michiana Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Michiana Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Bend Community School Corporation
• South Bend Emergency Physicians, Inc
• South Bend Ergonomics, LLC
• South Bend Family Dentistry, P.C.
• South Bend in Endoscopy ASC LLC
• South Bend Medical Foundation, Inc
• South Bend Medical Foundation, Inc
• South Bend Neurology, Inc.
• South Bend Optometrics, LLC
• South Bend Orthopaedic Associates, Inc.

• Ambulatory Surgical Clinic/Center in South Bend, IN
• Providers in South Bend, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.