Kiesha Anderson, D.O.
Individual provider Active NPI Clinical Neurophysiology Physician · Mishawaka, IN
NPI 1720439680 · NPPES record last updated May 18, 2026
Key facts
- NPI
- 1720439680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Neurophysiology Physician 2084N0600X
- License
- 02006115A (IN)
- Practice address
- 5314 Lincolnway E
Mishawaka, IN 46544-4249 - Phone
- (574) 647-8542
- NPI assigned
- Jun 22, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Neurology
- Education
- Edward Via Col of Osteo Medicine-Carolinas Campus, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Beacon Medical Group Inc
Practice addresses (Care Compare)
6913 N Main St
100 Beacon Medical Group Neurology
Granger, IN 46530-8039
Phone (574) 647-8542
Hospital & facility affiliations
- Memorial Hospital of South Bend
- Elkhart General Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Skin biopsy | 1-10 |
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 |
|---|---|---|---|---|
| I20210802001164 | IN | Practitioner - Neurology | 9133412422 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02006115A | IN | MD | Clinical Neurophysiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group Inc | Current |
Accepting new patients | |
| Beacon Medical Group, Inc. | Current | Accepting new patients | |
| Beacon Medical Group, Inc. | Neurology | Current |
Accepting new patients |
| Major Hospital | Past | Accepting new patients | |
| Beacon Medical Group, Inc. | Past | Accepting new patients |
Locations
6913 N Main St
Ste 100
Granger, IN 46530
Phone (574) 647-6400
3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129
900 I St
Laporte, IN 46350
Phone (219) 324-1670
5314 Lincolnway E
Mishawaka, IN 46544
Phone (574) 256-9032
100 Navarre Pl
Ste 6600
South Bend, IN 46601
Phone (574) 232-7227
Interoperability endpoints
- kanderson354841@direct-prd.stelizabeth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 02006115A | IN | |
| Clinical Neurophysiology Physician | 2084N0600X | 02006115A | IN | Yes |
Addresses
Primary practice location
5314 Lincolnway E
Mishawaka, IN 46544-4249
Mailing address
3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-3725
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201374980 | Medicaid | IN |
Other providers in Mishawaka, IN
- Amedisys Indiana, L.L.C
- American Health Muscular Therapy Clinic Inc
- Alexandria Anderson
- Andrew R Anderson
- Jane Elizabeth Anderson
- Jessica Andreen
- Miles Burton Andrew
- Gregory Andrianov
- Hari Priya Anne
- Christy Lynn Annis
All providers in Mishawaka, IN · Clinical Neurophysiology 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 May 18, 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.