Individual provider Active NPI

Mark A Thompson, M.D.

  • Surgery Physician
  • South Bend, IN
National Provider Identifier
1538136361
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01063692A Issued in IN
Practice address
621 Memorial Dr Ste 502
South Bend, IN 46601-1075
Phone
(574) 647-5875
Fax
(574) 647-5787
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01063692A IN Primary

Addresses

Primary practice location

621 Memorial Dr Ste 502
South Bend, IN 46601-1075

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-1840

Other practice location 1

900 I St
LA Porte, IN 46350-5533
Phone (219) 324-1700

Other practice location 2

1020 High Rd
Bremen, IN 46506-1093
Phone (574) 309-9967

Other identifiers 1

IdentifierTypeStateIssuer
200879410MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mthompson@mybeacon.cernerdirect.com

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071022000725 IN Practitioner - General SurgeryPractitioner - Vascular Surgery 6901992965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Indiana University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

621 Memorial Dr
Suite 502
South Bend, IN 46601-1075
Phone (574) 647-5875

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Colonoscopy1-10
Hernia repair - groin (open)12
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01063692AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. CurrentSince Jan 6, 2023 Accepting new patients
Beacon Medical Group Inc CurrentSince Jan 6, 2023 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

1020 High Rd
Bremen, IN 46506
Phone (574) 309-9967

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

900 I St
Laporte, IN 46350
Phone (219) 324-1670

621 Memorial Dr
Ste 502
South Bend, IN 46601
Phone (574) 234-9001

621 Memorial Dr
Ste 302
South Bend, IN 46601
Phone (574) 236-1888

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

Organizations & group practices 4

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.

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": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1538136361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "telephone_number": "574-647-1840",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 502",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011075",
            "telephone_number": "574-647-5875",
            "fax_number": "574-647-5787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 I St",
            "address_purpose": "LOCATION",
            "city": "LA Porte",
            "state": "IN",
            "postal_code": "463505533",
            "country_code": "US",
            "telephone_number": "219-324-1700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1020 High Rd",
            "address_purpose": "LOCATION",
            "city": "Bremen",
            "state": "IN",
            "postal_code": "465061093",
            "country_code": "US",
            "telephone_number": "574-309-9967",
            "fax_number": "574-309-9968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01063692A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200879410",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mthompson@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "621 Memorial Dr Ste 502",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.