Individual provider Active NPI

Collese McKee, FNP-C

  • Family Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1730810078
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71012904A Issued in IN
Practice address
17321 St Rd 23
South Bend, IN 46635-1531
Phone
(574) 335-8400
Fax
(574) 335-0796
NPI assigned
Jun 17, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71012904A IN Primary

Addresses

Primary practice location

17321 St Rd 23
South Bend, IN 46635-1531

Mailing address

707 Cedar St Ste 405
South Bend, IN 46617-2059

Other identifiers 2

IdentifierTypeStateIssuer
1102629698OtherINANTHEM
300065654MedicaidIN

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
I20220812002898 IN Practitioner - Nurse Practitioner 1759764483 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Joseph Regional Medical Center IncGroup PAC ID 8325950843, 137 clinicians

Practice addresses (Care Compare)

17321 State Rd
Suite 23
South Bend, IN 46635-1531
Phone (574) 335-8400

506 Michigan St
Walkerton, IN 46574-1116
Phone (574) 335-5200

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469

60101 Bodnar Blvd
Suite 100B
Mishawaka, IN 46544-9340
Phone (574) 335-8800

611 E Douglas Rd
Mishawaka, IN 46545-1467

611 E Douglas Rd
309 Infectious Diseases
Mishawaka, IN 46545-1469
Phone (574) 335-6770

Hospital & facility affiliations

  • Saint Joseph Vna Home Care Home health agency, South Bend, IN, CCN 157005
  • Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
  • Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71012904AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Nurse Practitioner CurrentSince Aug 10, 2022 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Family Current Accepting new patients
Saint Joseph Regional Medical Center, Inc. Nurse Practitioner CurrentSince Aug 10, 2022 Accepting new patients
Saint Joseph Regional Medical Center, Inc. Nurse Practitioner Current Accepting new patients

Locations

611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232

60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

510 W Adams St
Ste 150
Plymouth, IN 46563
Phone (574) 335-3987

17321 State Road 23
South Bend, IN 46635
Phone (574) 272-7676

707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328

707 Cedar St
Ste 405
South Bend, IN 46617

506 Michigan St
Walkerton, IN 46574
Phone (574) 586-9000

Interoperability endpoints

  • Direct secure messaging: cmckee1148558@direct.trinity-health.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1730810078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 405",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17321 ST RD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351531",
            "telephone_number": "574-335-8400",
            "fax_number": "574-335-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKEE",
        "first_name": "COLLESE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-17",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71012904A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "1102629698",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300065654",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.