Jacob Alexander Braddock, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02007857A Issued in IN

Practice address

714 N Michigan St
South Bend, IN 46601-1035

Phone

(574) 647-7477

Fax

(574) 647-3655

NPI assigned

May 6, 2021

Last updated

Jun 30, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN, KS, IL, IA, CO, MN6 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 6

Specialty

Family Practice

Education

Lake Erie College of Osteopathic Medicine, Erie, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Anthony Regional Hospital and Nursing HomeGroup PAC ID 4688586829, shared by 8 NPIs, 49 clinicians

Wayne County HospitalGroup PAC ID 4082508734, 46 clinicians

Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Anthony Regional Hospital & Nursing Home Hospital, Carroll, IA, CCN 161382
• Wayne County Hospital Hospital, Corydon, IA, CCN 161358
• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/wayneco-3602361a

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.

• Beacon Medical Group, Inc.

  dba Beacon Medical Group Schwartz - Wiekamp

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617
  Medicare reassignment Care Compare group NPD
• Wayne County Hospital

  • Critical Access Hospital
  • Corydon, IA
  • NPI 1174599468
  Medicare reassignment Care Compare group NPD
• Commonspirit Kansas, Inc.

  dba St. Catherine Hospital - Garden City

  • General Acute Care Hospital
  • Garden City, KS
  • NPI 1659360196
  Medicare reassignment NPD
• Crawford Hospital District

  dba Crawford Memorial Hospital

  • Internal Medicine Physician
  • Robinson, IL
  • NPI 1861423287

  Family Medicine

  Medicare reassignment NPD
• St Anthony Regional Hospital and Nursing Home

  • Critical Access Hospital
  • Carroll, IA
  • NPI 1720067127
  Medicare reassignment NPD
• St Anthony Regional Hospital and Nursing Home

  • Family Medicine Physician
  • Carroll, IA
  • NPI 1801815972
  Medicare reassignment NPD
• Banner Health Physicians Colorado LLC

  • Multi-Specialty Clinic/Center
  • Greeley, CO
  • NPI 1073899134
  Medicare reassignment
• Pipestone County Medical Center

  • Critical Access Hospital
  • Pipestone, MN
  • NPI 1447300587
  Medicare reassignment
• Pipestone County Medical Center

  • Critical Access Hospital
  • Pipestone, MN
  • NPI 1598751240
  Medicare reassignment
• Beacon Medical Group Inc

  dba Beacon Medical Group Anesthesia Elkhart

  • Anesthesiology Physician
  • Elkhart, IN
  • NPI 1437803285
  NPD
• Beacon Medical Group, Inc.

  dba Beacon Medical Group E. Blair Warner

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1609828946
  NPD
• Commonspirit Kansas, Inc.

  • Orthopaedic Surgery Physician
  • Dodge City, KS
  • NPI 1689386708
  NPD

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

• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Memorial Epworth Center

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Beacon Granger Hospital, A Memorial Hospital Extension

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  Care Compare affiliation
• St Anthony Regional Hospital and Nursing Home

  • Critical Access Hospital
  • Carroll, IA
  • NPI 1720067127
  Care Compare affiliation
• Wayne County Hospital

  • Critical Access Hospital
  • Corydon, IA
  • NPI 1174599468
  Care Compare affiliation

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

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1801470984",
    "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": "574-647-6592"
        },
        {
            "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",
            "fax_number": "574-647-3655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 W Ross Blvd Ste D",
            "address_purpose": "LOCATION",
            "city": "Dodge City",
            "state": "KS",
            "postal_code": "678017220",
            "country_code": "US",
            "telephone_number": "620-371-7044",
            "fax_number": "620-371-7046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Mercer Ave",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IN",
            "postal_code": "467332303",
            "country_code": "US",
            "telephone_number": "260-724-2145",
            "fax_number": "260-728-3867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADDOCK",
        "first_name": "JACOB",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-06",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02007857A",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "05-51049",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300091075",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Boyd, NP
• Jennifer Lynn Boyd, PHARMD
• Patrick William Boyle
• Brace Yourself Orthodontics LLC
• Dana G. Brackett, N.P.
• Lydia Bradfortd Otiato, MOT
• Angelene Bradley, MA
• David Anthony Bradley, RBT
• Leena Bradley
• Shanti Bradley, M.ED., MBA, BCBA

• Family Medicine Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.

Verify at the official NPI Registry.