Benjamin Haberly

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

10003022A Issued in IN

Practice address

53880 Carmichael Dr
South Bend, IN 46635-1567

Phone

(574) 247-9441

NPI assigned

Nov 17, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rci (WRS) LLCGroup PAC ID 5092624510, shared by 17 NPIs, 325 clinicians

Central Indiana Orthopedics LLCGroup PAC ID 5698667822, 148 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Unity Physicians Hospital Hospital, Mishawaka, IN, CCN 150177
• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
• Northwest Health-la Porte Hospital, La Porte, IN, CCN 150006
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076

Merit-based Incentive Payment System (MIPS)

Final score

81.81 of 100Reported as group

Quality

64.48

Promoting interoperability

96

Improvement activities

40

Cost

78.21

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: benjamin.haberly.2@13070.direct.athenahealth.com

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.

• Central Indiana Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Muncie, IN
  • NPI 1063422137
  Medicare reassignment Care Compare group NPD (past)
• Central Indiana Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
  • NPI 1669207023
  NPD
• Central Indiana Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Fishers, IN
  • NPI 1962061135
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• La Porte Hospital Company LLC

  • General Acute Care Hospital
  • La Porte, IN
  • NPI 1750746285
  Care Compare affiliation
• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  • General Acute Care Hospital
  • Plymouth, IN
  • NPI 1174571129
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation
• United Surgeons, LLC

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1518197011
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1679176200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 W BETHEL AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473045407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53880 CARMICHAEL DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351567",
            "telephone_number": "574-247-9441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60160 Bodnar Blvd",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465449338",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2349 Lake Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "IN",
            "postal_code": "465637837",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 S Nappanee St Ste F",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142066",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HABERLY",
        "first_name": "BENJAMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-17",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10003022A",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003022A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Gumm, RDH
• Jeremy L Gunter, FNP
• Melissa Gutierrez, PT
• Aidan Irene Gwartney
• Gwendolyn Dehorn LCSW LLC
• Nancy Jean Hadley, LCSW
• Almira Hadzimesic, NP
• Tracy Ann Haertling, D.O.
• Alison Haffner, NP
• Charles Frederick Hagenow, M.D.

• Surgical Physician Assistant in South Bend, IN
• Providers in South Bend, IN by specialty
• Surgical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.