Individual provider Active NPI

Stephanie Nichole Hicks, MD

  • Internal Medicine Physician
  • South Bend, IN
National Provider Identifier
1659647030
Registry record updated Mar 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01074045A Issued in IN
Practice address
615 N Michigan St 1St FL Hospitalist Ste
South Bend, IN 46601-1033
Phone
(574) 647-3281
Fax
(574) 647-1094
NPI assigned
Mar 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 01074045A IN
Internal Medicine Physician 207R00000X 01074045A 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) 647-3725

Other practice location 1

600 East Blvd 4th Floor Hospitalists Ste
Elkhart, IN 46514-2483
Phone (574) 389-7393

Other identifiers 2

IdentifierTypeStateIssuer
000000930702OtherINBCBS HOSPITALIST
201094290MedicaidIN

Other names 1

  • Stephanie Nichole Martin Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address snmartin@mybeacon.cernerdirect.com

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150716001585 IN Practitioner - Internal Medicine 0244463032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 2012
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

State licenses

LicenseStateTypeSpecialty
01074045AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Jul 20, 2015 Accepting new patients
Beacon Medical Group, Inc. Internal Medicine CurrentSince Jul 20, 2015 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients

Locations

600 East Blvd
Fl 4
Elkhart, IN 46514
Phone (574) 389-7393

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

900 I St
Laporte, IN 46350
Phone (219) 324-1670

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

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

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

Interoperability endpoints

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

Organizations & group practices 3

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 4

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": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774828800000",
    "number": "1659647030",
    "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": "574-647-3725"
        },
        {
            "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": "574-647-3281",
            "fax_number": "574-647-1094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 East Blvd 4th Floor Hospitalists Ste",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142483",
            "country_code": "US",
            "telephone_number": "574-389-7393",
            "fax_number": "574-647-1094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKS",
        "first_name": "STEPHANIE",
        "middle_name": "NICHOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-29",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01074045A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01074045A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPITALIST",
            "identifier": "000000930702",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201094290",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snmartin@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "615 N Michigan St",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "MARTIN",
            "middle_name": "NICHOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.