NPIMap

Individual provider Active NPI

Bethany Ann Wait, DO

  • Family Medicine Physician
  • South Bend, IN
National Provider Identifier
1447458096
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02003383A Issued in IN
Practice address
1901 W Western Ave Ste B
South Bend, IN 46619-3521
Phone
(574) 234-9033
Fax
(574) 847-7200
NPI assigned
Jul 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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 02003383A IN Primary

Addresses

Primary practice location

1901 W Western Ave Ste B
South Bend, IN 46619-3521

Mailing address

8003 Castleway Dr
Indianapolis, IN 46250-1946
Phone (317) 576-1335

Other identifiers 1

IdentifierTypeStateIssuer
02003383AOtherINPHYSICIAN

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
I20090306000493 IN Practitioner - Family PracticePractitioner - General Practice 6002972544 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indiana Health Centers Inc 63 clinicians

Practice addresses (Care Compare)

765 S Michigan St
Ihc Mi Street
South Bend, IN 46601-3101
Phone (574) 235-7990

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003383AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heart City Health Center, Inc. CurrentSince Nov 1, 2021 Accepting new patients
Goshen Family Physicians Family Medicine CurrentSince Aug 1, 2010 Accepting new patients
Heart City Health Center, Inc. CurrentSince Nov 1, 2021 Accepting new patients
Indiana Health Centers, Inc. Family Medicine CurrentSince Apr 1, 2023 Accepting new patients
Indiana Health Centers Inc CurrentSince Apr 1, 2023 Accepting new patients
Indiana Health Centers, Inc. Family Medicine Past Accepting new patients
Indiana Health Centers, Inc Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Indiana Health Centers, Inc. Family Medicine Past Accepting new patients
Memorial Hospital of South Bend Past Accepting new patients
Indiana Health Centers, Inc. Family Medicine Past Accepting new patients

Locations

1545 Cassopolis St
Elkhart, IN 46514
Phone (574) 584-2501

236 Simpson Ave
Elkhart, IN 46516
Phone (574) 293-0052

1811 Charlton Ct
Goshen, IN 46526
Phone (219) 534-8200

8003 Castleway Dr
Indianapolis, IN 46250
Phone (317) 576-1335

415 E Madison St
South Bend, IN 46617
Phone (574) 283-1234

1901 W Western Ave
Ste B
South Bend, IN 46619
Phone (574) 234-9033

765 S Michigan St
South Bend, IN 46601
Phone (574) 235-7990

1010 N Bendix Dr
South Bend, IN 46628
Phone (574) 245-4980

Organizations & group practices 21

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

View all 21

Hospital & facility affiliations 3

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": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1447458096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "317-576-1335",
            "fax_number": "317-343-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W WESTERN AVE STE B",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466193521",
            "telephone_number": "574-234-9033",
            "fax_number": "574-847-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAIT",
        "first_name": "BETHANY",
        "middle_name": "ANN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-05",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003383A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN",
            "identifier": "02003383A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.