Individual provider Active NPI

Celestina I. Iheanacho, MD

  • Internal Medicine Physician
  • South Bend, IN
National Provider Identifier
1619927530
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01091247A Issued in IN
Practice address
615 N Michigan St 1St FL Hospitalist Ste
South Bend, IN 46601-1033
Phone
(574) 647-3050
Fax
(574) 647-1094
NPI assigned
May 11, 2006
Last updated
Oct 2, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01091247A IN Primary

Addresses

Primary practice location

615 N Michigan St 1St FL Hospitalist Ste
South Bend, IN 46601-1033

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-2129

Other identifiers 1

IdentifierTypeStateIssuer
300080496MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, IN2 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
I20060323000610 NC Practitioner - Nurse Practitioner 7911915558
I20230913003982 IN Practitioner - Internal Medicine 7911915558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
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)

615 N Michigan St FL
1 Beacon Medical Group Hospital Spec
South Bend, IN 46601-1033
Phone (574) 647-3050

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Sep 25, 2023 Accepting new patients
Beacon Medical Group, Inc. Internal Medicine CurrentSince Sep 25, 2023 Accepting new patients
Physicians Eldercare PA Past Accepting new patients

Locations

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

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

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

Hospital & facility affiliations 5

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1619927530",
    "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": "574-647-2129",
            "fax_number": "336-251-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST 1ST FL HOSPITALIST STE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-3050",
            "fax_number": "574-647-1094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IHEANACHO",
        "first_name": "CELESTINA",
        "middle_name": "I.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01091247A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300080496",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.