Individual provider Active NPI

Daniel Homuth

  • Diagnostic Radiology Physician
  • Indianapolis, IN
National Provider Identifier
1578094082
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
02006591A Issued in IN
Practice address
355 W 16TH St Ste 4100
Indianapolis, IN 46202-2394
Phone
(317) 963-7171
NPI assigned
Mar 26, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 02006591A IN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

355 W 16TH St Ste 4100
Indianapolis, IN 46202-2394

Mailing address

355 W 16TH St Ste 4100
Indianapolis, IN 46202-2394
Phone (317) 963-7171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230725004027 IN Practitioner - Diagnostic Radiology 3476822974 Reassigns benefits to 1 organization
I20230830004090 MI Practitioner - Diagnostic Radiology 3476822974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Nova Southeastern College of Osteo Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology IncGroup PAC ID 5890695464, 35 clinicians

Practice addresses (Care Compare)

100 Navarre PL
Suite 5510
South Bend, IN 46601-1172
Phone (574) 647-7742

1010 W State Rd
Suite 2
La Porte, IN 46350-5465
Phone (574) 258-1100

1020 High Rd
Bremen, IN 46506-1093
Phone (574) 546-2211

1115 Professional Dr
Goshen, IN 46526-3800
Phone (574) 364-4850

1135 Professional Dr
Goshen, IN 46526-3800
Phone (574) 364-4000

12765 Brick Rd
Granger, IN 46530-6818
Phone (574) 258-1100

200 High Park Ave
Goshen, IN 46526-4810
Phone (574) 535-2693

303 S Nappanee St
Elkhart Clinic
Elkhart, IN 46514-2066
Phone (574) 296-3365

600 E Blvd
Elkhart, IN 46514-2483
Phone (574) 294-2621

615 N Michigan St
Memorial Hospital
South Bend, IN 46601-1033
Phone (574) 647-1000

6901 N Main St
Memorial Lighthouse Imaging Center
Granger, IN 46530-8022
Phone (574) 647-2900

701 S Health Pkwy
Three Rivers, MI 49093-8352
Phone (269) 278-1145

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Goshen Hospital Hospital, Goshen, IN, CCN 150026
  • Three Rivers Health Hospital, Three Rivers, MI, CCN 230015
  • Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology, Inc Diagnostic Radiology CurrentSince Aug 1, 2023 Accepting new patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Mar 23, 2026 Accepting new patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Sep 1, 2023 Accepting new patients

Locations

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

1020 High Rd
#O
Bremen, IN 46506
Phone (574) 284-3086

303 S Nappanee St
Elkhart, IN 46514

600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621

1115 Professional Dr
Goshen, IN 46526
Phone (574) 364-4850

200 High Park Ave
Goshen, IN 46526
Phone (219) 533-2141

6901 N Main St
Granger, IN 46530
Phone (574) 647-2900

102 E Culver Rd
Knox, IN 46534
Phone (574) 772-1580

1331 State St
Laporte, IN 46350
Phone (219) 326-2415

620 W Edison Rd
Ste 110
Mishawaka, IN 46545
Phone 5742581100 ext. 239

100 Navarre Pl
South Bend, IN 46601
Phone (574) 235-1010

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

701 S Health Parkway
Three Rivers, MI 49093
Phone (269) 273-9691

Organizations & group practices 3

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 7

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": "1490486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1578094082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST STE 4100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022394",
            "telephone_number": "317-963-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST STE 4100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022394",
            "telephone_number": "317-963-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMUTH",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-26",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "02006591A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.