Individual provider Active NPI

Shana'E C Sobieray, AUD

  • Audiologist
  • South Bend, IN
National Provider Identifier
1598285686
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
23002625A Issued in IN
Practice address
100 Navarre PL Ste 4460
South Bend, IN 46601-1168
Phone
(574) 235-1010
Fax
(574) 232-2064
NPI assigned
Jun 21, 2017
Last updated
Apr 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 23002625A IN Primary

Addresses

Primary practice location

100 Navarre PL Ste 4460
South Bend, IN 46601-1168

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 1

IdentifierTypeStateIssuer
300003999MedicaidIN

Other names 1

  • Shana'E N Clark Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssobieray@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170707000465 IN Practitioner - Qualified Audiologist 1254600257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2017
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)

100 Navarre PL
4460 BMG ENT and Audiology South Bend
South Bend, IN 46601-1168
Phone (574) 235-1010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Jan 27, 2021 Accepting new patients
Beacon Medical Group, Inc. CurrentSince Jan 27, 2021 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

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

100 Navarre Pl
Ste 4460
South Bend, IN 46601
Phone (574) 234-0049

615 N Michigan St
Fl 1
South Bend, IN 46601
Phone (574) 647-1100

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

Interoperability endpoints

  • Direct secure messaging: ssobieray@mybeacon.cernerdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1598285686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 4460",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011168",
            "telephone_number": "574-235-1010",
            "fax_number": "574-232-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBIERAY",
        "first_name": "SHANA'E",
        "middle_name": "C",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23002625A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300003999",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssobieray@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "100 Navarre Pl Ste 4460",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011168",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANA'E",
            "last_name": "CLARK",
            "middle_name": "N",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.