Individual provider Active NPI

Shelby Patterson, FNP-C

  • Family Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1710611603
Registry record updated Oct 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71012807A Issued in IN
Practice address
1815 E Ireland Rd
South Bend, IN 46614-2845
Phone
(574) 647-1700
NPI assigned
Jul 15, 2022
Last updated
Oct 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X 28220040A IN
Family Nurse Practitioner 363LF0000X 71012807A IN Primary

Addresses

Primary practice location

1815 E Ireland Rd
South Bend, IN 46614-2845

Mailing address

18591 S Cypress Cir
South Bend, IN 46637-4615
Phone (574) 309-4594

Other names 1

  • Shelby Giles Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221102002229 IN Practitioner - Nurse Practitioner 1557738663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
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)

1815 E Ireland Rd
Beacon Medical Group Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71012807AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Family CurrentSince Oct 9, 2022 Accepting new patients
Beacon Medical Group Inc CurrentSince Oct 9, 2022 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (269) 552-2823

1815 E Ireland Rd
South Bend, IN 46614
Phone (574) 647-1700

Organizations & group practices 4

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 3

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": "1657843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666396800000",
    "number": "1710611603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18591 S CYPRESS CIR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466374615",
            "telephone_number": "574-309-4594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E IRELAND RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466142845",
            "telephone_number": "574-647-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "SHELBY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-15",
        "last_updated": "2022-10-22",
        "certification_date": "2022-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "IN",
            "license": "28220040A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71012807A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "GILES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.