Individual provider Active NPI

Lisa Marie Michalski

  • Family Nurse Practitioner
  • Mishawaka, IN
National Provider Identifier
1619702040
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2023058906 Issued in IN
Practice address
611 E Douglas Rd
Mishawaka, IN 46545-1464
Phone
(574) 335-6700
NPI assigned
Sep 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2023058906 IN Primary

Addresses

Primary practice location

611 E Douglas Rd
Mishawaka, IN 46545-1464

Mailing address

925 Potter Point Dr
South Bend, IN 46614-3469
Phone (574) 299-3863

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241018000543 IN Practitioner - Nurse Practitioner 3375075096 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Joseph Regional Medical Center IncGroup PAC ID 8325950843, 137 clinicians

Practice addresses (Care Compare)

611 E Douglas Rd
Mishawaka, IN 46545-1465
Phone (574) 335-6000

Hospital & facility affiliations

  • Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
  • Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2023058906INMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center, Inc. CurrentSince Oct 1, 2024 Accepting new patients
Saint Joseph Regional Medical Center, Inc. Family CurrentSince Oct 1, 2024 Accepting new patients

Locations

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

611 E Douglas Rd
Ste 208
Mishawaka, IN 46545
Phone (574) 232-5928

611 E Douglas Rd
Mishawaka, IN 46545
Phone (574) 335-6500

611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232

616 E 13th St
Winamac, IN 46996
Phone (574) 946-2100

Interoperability endpoints

  • Direct secure messaging: lmichalski1142433@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.

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": "1725494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1619702040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 POTTER POINT DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466143469",
            "telephone_number": "574-299-3863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451464",
            "telephone_number": "574-335-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHALSKI",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "2023058906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.