Active NPI
Kelsey Perry, MD CANDIDATE
- Family Medicine Physician
- South Bend, IN
National Provider Identifier
1730758673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01098999A
- Practice address
- 714 N Michigan St
South Bend, IN 46601-1035 - Phone
- (574) 647-7477
- NPI assigned
- Jun 24, 2021
- Sex
- Female
- 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 | 01098999A | IN | Primary |
Addresses
Primary practice location
714 N Michigan St
South Bend, IN 46601-1035
Mailing address
3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-3725
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300076538 | Medicaid | IN |
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 |
|---|---|---|---|---|
| I20230607003711 | IN | Order and Referring Only - Family Practice | 7416314372 |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3245 Health Dr
Suite 100
Granger, IN 46530-1380
Hospital & facility affiliations
- Memorial Hospital of South Bend
- Wellbrooke of South Bend
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- South Bend, IN
- NPI 1295772093
-
- Psychiatric Hospital Unit
- South Bend, IN
- NPI 1376841395
-
- General Acute Care Hospital
- Granger, IN
- NPI 1881177756
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784505600000",
"number": "1730758673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3245 HEALTH DR STE 100",
"city": "GRANGER",
"state": "IN",
"postal_code": "465301380",
"telephone_number": "574-647-3725"
},
{
"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": "PERRY",
"first_name": "KELSEY",
"credential": "MD CANDIDATE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-24",
"last_updated": "2026-07-20",
"certification_date": "2026-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01098999A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300076538",
"state": "IN"
}
],
"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 Jul 20, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.