Active NPI
Jennifer L Ludwig, MD
- Family Medicine Physician
- Mishawaka, IN
National Provider Identifier
1629095203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01047304
- Practice address
- 611 E Douglas Rd
Ste 407
Mishawaka, IN 46545-1464 - Phone
- (574) 335-6500
- Fax
- (574) 335-0772
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01047304 | IN | Primary |
Addresses
Primary practice location
611 E Douglas Rd
Ste 407
Mishawaka, IN 46545-1464
Mailing address
611 E Douglas Rd
Ste 407
Mishawaka, IN 46545-1464
Phone (574) 335-6500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200105660 | Medicaid | IN | |
| 200105660A | Other | IN | MEDICAID |
| 738460IIII | Other | IN | MEDICARE PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Air Angels Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Air Ambulance
- West Chicago, IL
- NPI 1316949951
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360627200000",
"number": "1629095203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 E DOUGLAS RD",
"address_2": "STE 407",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451464",
"telephone_number": "574-335-6500",
"fax_number": "574-335-0772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 E DOUGLAS RD",
"address_2": "STE 407",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451464",
"telephone_number": "574-335-6500",
"fax_number": "574-335-0772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUDWIG",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2013-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01047304",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200105660",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "200105660A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER NUMBER",
"identifier": "738460IIII",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.