Charles Higgs-Coulthard, M.D.
Individual provider Active NPI Family Medicine Physician · Mishawaka, IN
NPI 1447205448 · NPPES record last updated Oct 25, 2023
Key facts
- NPI
- 1447205448
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01042925 (IN)
- Practice address
- 611 E Douglas Rd Ste 406
Mishawaka, IN 46545-1468 - Phone
- (574) 335-6580
- Fax
- (574) 335-0796
- NPI assigned
- May 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Creighton University School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Joseph Regional Medical Center Inc
Saint Joseph Regional Medical Center-South Bend Campus Inc
Practice addresses (Care Compare)
209 E Jefferson St
Plymouth Family and Internal Medicine DT
Plymouth, IN 46563-1861
Phone (574) 948-5100
611 E Douglas Rd
Suite 406 Family Medicine Faculty Physicia
Mishawaka, IN 46545-1468
Phone (574) 335-6580
Hospital & facility affiliations
- Saint Joseph Vna Home Care
- Saint Joseph Regional Medical Center
- Memorial Hospital of South Bend
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100708000743 | IN | Practitioner - Family Practice | 3173654142 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01042925 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center-South Bend Campus, Inc. | Family Medicine | Current |
Accepting new patients |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc | Current | Accepting new patients | |
| Saint Joseph Regional Medical Center, Inc. | Current | Accepting new patients | |
| Advanced Kidney Care Medical Associates, P.C. | Past | Accepting new patients |
Locations
60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500
611 E Douglas Rd
Ste 407
Mishawaka, IN 46545
Phone (574) 335-6500
611 E Douglas Rd
Ste 105
Mishawaka, IN 46545
Phone (574) 335-6585
611 E Douglas Rd
Ste 406
Mishawaka, IN 46545
Phone (574) 335-6500
5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443
611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232
611 E Douglas Rd
Ste 137
Mishawaka, IN 46545
Phone (574) 335-6214
209 E Jefferson St
Plymouth, IN 46563
Phone (574) 941-3111
707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328
Interoperability endpoints
- chiggscoulthard84994@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01042925 | IN | Yes |
Addresses
Primary practice location
611 E Douglas Rd Ste 406
Mishawaka, IN 46545-1468
Mailing address
707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100325690A | Medicaid | IN |
Other providers in Mishawaka, IN
- Mary Hess
- Hewitt and Feltzer Dentistry Partnership
- Hewlett Zaremba LLC
- Leonard A. Hickman
- Evonne Higdon
- Helene M Highbarger
- Maya Ann Hightower
- Alyssa Hile
- Jessica Pauline Hiler
- John C Hill
All providers in Mishawaka, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.