Active NPI
Deidre A Coffey, FNP
- Family Nurse Practitioner
- South Bend, IN
National Provider Identifier
1467747014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 28133609A
- Practice address
- 1122 S Ironwood Dr
South Bend, IN 46615-1618 - Phone
- (574) 335-8399
- Fax
- (574) 335-0786
- NPI assigned
- Jun 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 28133609A | IN | Primary |
Addresses
Primary practice location
1122 S Ironwood Dr
South Bend, IN 46615-1618
Mailing address
5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-8399
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201025560 | Medicaid | IN |
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110719000135 | IN | Practitioner - Nurse Practitioner | 5890963805 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Joseph Regional Medical Center Inc
Practice addresses (Care Compare)
1122 S Ironwood Dr
River Park Family Medicine
South Bend, IN 46615-1618
Phone (574) 335-8399
Hospital & facility affiliations
- Saint Joseph Vna Home Care
- Saint Joseph Regional Medical Center
- Saint Joseph Regional Medical Center - Plymouth
- Memorial Hospital of South Bend
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28133609A | IN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center, Inc. | Current | Accepting new patients |
Locations
611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232
5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443
60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500
707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328
Interoperability endpoints
- dcoffey1147710@direct.trinity-health.org
Organizations & group practices 2
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.
-
- Pulmonary Disease Physician
- Plymouth, IN
- NPI 1225082878
IN
-
- Home Infusion Agency
- Mishawaka, IN
- NPI 1255369500
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Plymouth, IN
- NPI 1174571129
Hospital
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1023965795
Hospital
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1841245594
Hospital
-
- Home Health Agency
- South Bend, IN
- NPI 1093746562
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768176000000",
"number": "1467747014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5215 HOLY CROSS PKWY",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451469",
"telephone_number": "574-335-8399",
"fax_number": "574-335-0786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 S IRONWOOD DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466151618",
"telephone_number": "574-335-8399",
"fax_number": "574-335-0786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COFFEY",
"first_name": "DEIDRE",
"middle_name": "A",
"name_prefix": "Miss",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-12",
"last_updated": "2026-01-12",
"certification_date": "2026-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "28133609A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201025560",
"state": "IN"
}
],
"endpoints": [],
"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 Jan 12, 2026; 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.