Individual provider Active NPI

Nomin Groves, DDS

  • Endodontics
  • South Bend, IN
National Provider Identifier
1720639842
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
12013289A Issued in IN
Practice address
225 N Notre Dame Ave Ste 2
South Bend, IN 46617-2836
Phone
(574) 233-4444
NPI assigned
Sep 20, 2019
Last updated
Oct 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 12013289A IN Primary

Addresses

Primary practice location

225 N Notre Dame Ave Ste 2
South Bend, IN 46617-2836

Mailing address

225 N Notre Dame Ave Ste 2
South Bend, IN 46617-2836
Phone (574) 232-5866

Other practice location 1

4341 Flagstaff Cv
Fort Wayne, IN 46815-4400
Phone (260) 800-3288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
12013289AINMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Risser Endodontics P.C. Endodontics PastSince Oct 5, 2025 Accepting new patients
Northside Anesthesia Services, LLC PastSince Jan 1, 2020 Accepting new patients

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": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1720639842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N NOTRE DAME AVE STE 2",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172836",
            "telephone_number": "574-232-5866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N NOTRE DAME AVE STE 2",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172836",
            "telephone_number": "574-233-4444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4341 Flagstaff Cv",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468154400",
            "country_code": "US",
            "telephone_number": "260-800-3288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROVES",
        "first_name": "NOMIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-20",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IN",
            "license": "12013289A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.