Individual provider Active NPI

Bryan Lee Stowell

  • Pediatric Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1720460314
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
28219432A Issued in IN
Practice address
211 N Eddy St
South Bend, IN 46617-2808
Phone
(574) 234-8161
NPI assigned
Jun 19, 2015
Last updated
Mar 12, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 28219432A IN Primary

Addresses

Primary practice location

211 N Eddy St
South Bend, IN 46617-2808

Mailing address

211 N Eddy St
South Bend, IN 46617-3096
Phone (574) 234-8161

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
I20150930002958 IN Practitioner - Nurse Practitioner 6204144876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Vanderbilt University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 234-8161

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28219432AINMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic LLC CurrentSince Aug 29, 2015 Accepting new patients
The South Bend Clinic, LLC CurrentSince Aug 29, 2015 Accepting new patients

Locations

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

Interoperability endpoints

  • Direct secure messaging: bstowell255371@dulyhealthandcare.direct-ci.com
  • FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1720460314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173096",
            "telephone_number": "574-234-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172808",
            "telephone_number": "574-234-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOWELL",
        "first_name": "BRYAN",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-19",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "28219432A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.