NPIMap

Individual provider Active NPI

Jonathan Michael McCrea, M.D.

  • Diagnostic Radiology Physician
  • South Bend, IN
National Provider Identifier
1700048923
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01072365A Issued in IN
Practice address
121 S Saint Louis Blvd
South Bend, IN 46617-2924
Phone
(574) 233-3123
Fax
(574) 233-3125
NPI assigned
Jun 29, 2008
Last updated
Nov 26, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01072365A IN Primary

Addresses

Primary practice location

121 S Saint Louis Blvd
South Bend, IN 46617-2924

Mailing address

121 S Saint Louis Blvd
South Bend, IN 46617-2924
Phone (574) 233-3123

Other identifiers 1

IdentifierTypeStateIssuer
201155790MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130905000648 IN Practitioner - Diagnostic Radiology 0345499505 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Huron Valley Radiology PCGroup PAC ID 2961466859, 76 clinicians
X-Ray Consultants IncGroup PAC ID 7315859832, 38 clinicians

Practice addresses (Care Compare)

South Bend, IN 46617

121 S Saint Louis Blvd
South Bend, IN 46617-2924
Phone (219) 233-3123

1915 Lake Ave
Plymouth, IN 46563-9366
Phone (574) 936-3181

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-5000

5340 Holy Cross Pkwy
Mishawaka, IN 46545-1470
Phone (574) 237-1328

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc Current Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Current Accepting new patients
Huron Valley Radiology PC Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
X-Ray Consultants Inc Diagnostic Radiology CurrentSince Jul 1, 2013 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc CurrentSince Mar 11, 2022 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. CurrentSince Mar 11, 2022 Accepting new patients

Locations

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

611 E Douglas Rd
Ste 122
Mishawaka, IN 46545
Phone (574) 272-9991

611 E Douglas Rd
Ste 137
Mishawaka, IN 46545
Phone (574) 335-6214

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

510 W Adams St
Ste 150
Plymouth, IN 46563
Phone (574) 335-3987

121 S Saint Louis Blvd
South Bend, IN 46617
Phone (219) 233-3123

Interoperability endpoints

  • Direct secure messaging: jmccrea1147599@direct.trinity-health.org

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1214697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416960000000",
    "number": "1700048923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S SAINT LOUIS BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172924",
            "telephone_number": "574-233-3123",
            "fax_number": "574-233-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S SAINT LOUIS BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172924",
            "telephone_number": "574-233-3123",
            "fax_number": "574-233-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCREA",
        "first_name": "JONATHAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-29",
        "last_updated": "2014-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01072365A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201155790",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.