Active NPI
Angela Marie Wright, PA
- Physician Assistant
- Mishawaka, IN
National Provider Identifier
1508013418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10001017A
- Practice address
- 810 Park Place
Mishawaka, IN 46545 - Phone
- (574) 366-0240
- Fax
- (574) 366-0218
- NPI assigned
- Aug 21, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10001017A | IN | Primary |
| Physician Assistant | 363A00000X | 99032985A | IN |
Addresses
Primary practice location
810 Park Place
Mishawaka, IN 46545
Mailing address
810 Park Place
Mishawaka, IN 46545
Phone (574) 366-0240
Other practice location 1
2600 Greenbush St
Lafayette, IN 47904-2477
Phone (765) 448-8000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000586619 | Other | IN | ANTHEM PROVIDER NUMBER |
| 236040442 | Other | IN | MEDICARE |
| 300013545 | Medicaid | IN |
Other names 1
- Angela Marie Gordon
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 |
|---|---|---|---|---|
| I20081230000452 | IN | Practitioner - Physician Assistant | 9638231558 | Reassigns benefits to 5 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1753 Fulton St
Elkhart, IN 46514-1927
Phone (574) 293-9448
6913 N Main St
Granger, IN 46530-8039
810 Park PL
Mishawaka, IN 46545-3520
Phone (574) 366-0240
Hospital & facility affiliations
- Elkhart General Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99032985A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group Inc | Current | Accepting new patients | |
| Beacon Medical Group, Inc. | Current | Accepting new patients |
Locations
1753 Fulton St
Elkhart, IN 46514
Phone (574) 293-9448
600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621
6913 N Main St
Granger, IN 46530
Phone (574) 647-1500
Organizations & group practices 7
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.
-
- General Practice Physician
- Indianapolis, IN
- NPI 1902032832
IN
-
- Anesthesiology Physician
- Elkhart, IN
- NPI 1437803285
-
- Family Medicine Physician
- Bristol, IN
- NPI 1447285697
Hospital & facility affiliations 1
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": "1219276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767312000000",
"number": "1508013418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 PARK PLACE",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "46545",
"telephone_number": "574-366-0240",
"fax_number": "574-366-0218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 PARK PLACE",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "46545",
"telephone_number": "574-366-0240",
"fax_number": "574-366-0218"
}
],
"practiceLocations": [
{
"address_1": "2600 Greenbush St",
"address_purpose": "LOCATION",
"city": "Lafayette",
"state": "IN",
"postal_code": "479042477",
"country_code": "US",
"telephone_number": "765-448-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WRIGHT",
"first_name": "ANGELA",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-21",
"last_updated": "2026-01-02",
"certification_date": "2026-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10001017A",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "99032985A",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "000000586619",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "236040442",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300013545",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ANGELA",
"last_name": "GORDON",
"middle_name": "MARIE",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.