Edith M Cullen, M.D.
Individual provider Active NPI Sports Medicine (Family Medicine) Physician · Elkhart, IN
NPI 1720073521 · NPPES record last updated Jul 28, 2026
Key facts
- NPI
- 1720073521
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- License
- 01061215A (IN)
- Practice address
- 2310 California Rd
Elkhart, IN 46514-1228 - Phone
- (574) 264-4163
- Fax
- (574) 262-9650
- NPI assigned
- Sep 19, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Texas Tech University Health Science Center School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Orthopedic and Sports Medicine Center of Northern Indiana Inc
Practice addresses (Care Compare)
1775 E Kercher Rd
Orthopedic and Sports Medicine Center
Goshen, IN 46526-6308
Phone (574) 533-0300
Hospital & facility affiliations
- Goshen Hospital
- Elkhart General Hospital
- Memorial Hospital of South Bend
- Greencroft Healthcare
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.85 of 100
- Quality
- 59.71
- Promoting interoperability
- 90
- Improvement activities
- 40
- Cost
- 88.11
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130906000696 | IN | Practitioner - Family Practice |
2668610734 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| ASC Surgical Ventures, LLC | Past | Accepting new patients |
Interoperability endpoints
- edith.cullen@direct.osmc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 01061215A | IN | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 01061215A | IN | Yes |
Addresses
Primary practice location
2310 California Rd
Elkhart, IN 46514-1228
Mailing address
2310 California Rd Ste a
Elkhart, IN 46514-1228
Phone (574) 264-0791
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201092890 | Medicaid | IN |
Other providers in Elkhart, IN
- Skye Critchlow
- Emily Crone
- Crossroads Healing Arts, LLC
- Geneele Crump-Campagnoli
- Amber Cruz
- Natalie D Cullinane
- Cynthia Culver
- Maria Daniela Cumache Medina
- Stephanie L Cundiff
- Demara Cunningham
All providers in Elkhart, IN · Sports Medicine (Family Medicine) Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.