Active NPI
Evans Kirkwood Lodge, MD, PHD
- Family Medicine Physician
- South Bend, IN
National Provider Identifier
1710737366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01097297A
- Practice address
- 714 N Michigan St
South Bend, IN 46601-1035 - Phone
- (574) 647-7477
- NPI assigned
- Mar 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01097297A | IN | Primary |
Addresses
Primary practice location
714 N Michigan St
South Bend, IN 46601-1035
Mailing address
714 N Michigan St
South Bend, IN 46601-1035
Phone (574) 647-7477
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240518000461 | IN | Order and Referring Only - Family Practice | 2860833027 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01097297A | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765152000000",
"number": "1710737366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 N MICHIGAN ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011035",
"telephone_number": "574-647-7477",
"fax_number": "574-647-6819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 N MICHIGAN ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011035",
"telephone_number": "574-647-7477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODGE",
"first_name": "EVANS",
"middle_name": "KIRKWOOD",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-26",
"last_updated": "2025-12-08",
"certification_date": "2025-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01097297A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.