Kevin M Small, MD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

01044597A Issued in IN

Practice address

621 Memorial Dr Ste 312
South Bend, IN 46601-1073

Phone

(574) 647-5200

Fax

(574) 647-5210

NPI assigned

Sep 14, 2005

Last updated

Apr 5, 2021By the provider in NPPES

Sex

Male

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN, TX2 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

Specialty

Diagnostic RadiologyAlso: Interventional Radiology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiology IncGroup PAC ID 5890695464, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
• Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Radiology, Inc

  • Diagnostic Radiology Physician
  • Mishawaka, IN
  • NPI 1578557815

  TX, Vascular & Interventional Radiology

  Medicare reassignment Care Compare group NPD
• Beacon Medical Group, Inc.

  dba Beacon Medical Group Schwartz - Wiekamp

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617
  Medicare reassignment NPD
• Beacon Health, LLC

  dba Beacon Imaging Mishawaka

  • Diagnostic Radiology Physician
  • Mishawaka, IN
  • NPI 1912796699
  NPD
• Beacon Health, LLC

  dba Beacon Imaging

  • Diagnostic Radiology Physician
  • Goshen, IN
  • NPI 1952982217
  NPD
• Beacon Medical Group Inc

  dba Beacon Medical Group Anesthesia Elkhart

  • Anesthesiology Physician
  • Elkhart, IN
  • NPI 1437803285
  NPD
• Beacon Medical Group, Inc.

  dba Beacon Bone and Joint Specialists

  • Critical Care Medicine (Internal Medicine) Physician
  • Elkhart, IN
  • NPI 1821222829

  Vascular & Interventional Radiology

  NPD
• Beacon Medical Group, Inc.

  dba Beacon Medical Group Vascular Interventional Radiology

  • Vascular & Interventional Radiology Physician
  • South Bend, IN
  • NPI 1932468352
  NPD (past)
• Memorial Lighthouse Imaging LLC

  • Diagnostic Ultrasound Physician
  • South Bend, IN
  • NPI 1730225848
  NPD (past)

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

• Elkhart General Hospital, Inc.

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1477551489
  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Memorial Epworth Center

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Beacon Granger Hospital, A Memorial Hospital Extension

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • 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": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1689669715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 312",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011073",
            "telephone_number": "574-647-5200",
            "fax_number": "574-647-5210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 W Edison Rd",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465452784",
            "country_code": "US",
            "telephone_number": "574-258-1100 x239",
            "fax_number": "574-258-1101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMALL",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IN",
            "license": "01044597A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200181930",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmall@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "621 Memorial Dr Ste 312",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Anne Slepko, CAA
• Siarhei Slinko
• Dennis Martin Slovacek, RPH
• Noah Slovinski, RBT
• Abriella Violetlee Smale-Miller
• Serena Smallwood
• Melissa Smeltzer-Carpenter, MA
• Angela Marie Smilgius, LCSW
• Lori Smith-Kaminsky, PHARMD
• Abbee Dallek Smith, LCSW

• Vascular & Interventional Radiology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Vascular & Interventional Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.