Individual provider Active NPI

Mackenzie Linn Griman, PA-C

  • Surgical Physician Assistant
  • Elkhart, IN
National Provider Identifier
1740170968
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
500 Arcade Ave Ste 230
Elkhart, IN 46514-2485
Phone
(572) 522-6565
NPI assigned
Jul 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

500 Arcade Ave Ste 230
Elkhart, IN 46514-2485

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other practice location 1

610 N Michigan St Ste 306
South Bend, IN 46601-1079
Phone (574) 647-6500

Other identifiers 1

IdentifierTypeStateIssuer
300118511MedicaidIN

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
I20250821000507 IN Practitioner - Physician Assistant 4385144716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

500 Arcade Ave
Elkhart, IN 46514-2485

600 E Blvd
Elkhart, IN 46514-2483

600 E Blvd 4TH FL Hospitalists
BMG Hospital Specialties
Elkhart, IN 46514-2483
Phone (574) 647-3050

615 N Michigan St
South Bend, IN 46601-1033

615 N Michigan St FL
South Bend, IN 46601-1033

6913 N Main St
Granger, IN 46530-8039

Hospital & facility affiliations

  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Oct 6, 2025 Accepting new patients
Beacon Medical Group, Inc. CurrentSince Oct 6, 2025 Accepting new patients

Locations

500 Arcade Ave
Ste 230
Elkhart, IN 46514
Phone (574) 522-6565

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

610 N Michigan St
Ste 306
South Bend, IN 46601
Phone (574) 647-6500

Organizations & group practices 3

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": "1751932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1740170968",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 230",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142485",
            "telephone_number": "572-522-6565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 N Michigan St Ste 306",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011079",
            "country_code": "US",
            "telephone_number": "574-647-6500",
            "fax_number": "574-647-6518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIMAN",
        "first_name": "MACKENZIE",
        "middle_name": "LINN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-08",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300118511",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.