Marilyn Ross

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05002653A Issued in IN

Practice address

53940 Carmichael Dr
South Bend, IN 46635-1564

Phone

(574) 335-6212

NPI assigned

Sep 17, 2020

Last updated

Mar 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Saint Joseph Regional Medical Center-South Bend Campus, Inc

  dba Saint Joseph Regional Medical Center-South Bend Campus Inc Mobile Med

  • Mobile Mammography Clinic/Center
  • South Bend, IN
  • NPI 1023844693
  Medicare reassignment NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  NPD

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1649886490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 406",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172059",
            "telephone_number": "574-335-8707",
            "fax_number": "574-335-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53940 CARMICHAEL DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351564",
            "telephone_number": "574-335-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "MARILYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-17",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05002653A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300043421",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tatum Nicole Rose
• Charles Rosenbaum, D.D.S.
• Sara Marie Rosenberg
• Jonathan Rosengren, MSW
• Alexandra Rain Ross, PHARMD
• Nicole Ross, PMHNP
• Tonya Darlene Ross
• Trinity Ross, RBT
• Betsy Rossow, MD
• Janya Lajoyce Roston

• Physical Therapist in South Bend, IN
• Providers in South Bend, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.