Individual provider Active NPI

Colin Talanda Fath, M.D.

  • Surgical Critical Care Physician
  • Elkhart, IN
National Provider Identifier
1811300817
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
01091291A Issued in IN
Practice address
500 Arcade Ave Ste 320
Elkhart, IN 46514-2477
Phone
(574) 523-7900
Fax
(574) 523-7909
NPI assigned
Jun 6, 2014
Last updated
Oct 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R-10033 IA
Surgery Physician 208600000X 52660 KY
Surgery Physician 208600000X 01091291A IN
Surgical Critical Care Physician 2086S0102X 52660 KY
Surgical Critical Care Physician 2086S0102X 01091291A IN Primary
Trauma Surgery Physician 2086S0127X 4301505625 MI

Addresses

Primary practice location

500 Arcade Ave Ste 320
Elkhart, IN 46514-2477

Mailing address

3245 Health Dr Ste 100
South Bend, IN 46530-1380

Other practice location 1

University Of Kentucky General Surgery 800 Rose St
Lexington, KY 40536-1009
Phone (859) 323-5860

Other practice location 2

621 Memorial Dr
Suite 502
South Bend, IN 46601-1075
Phone (574) 647-5875

Other identifiers 1

IdentifierTypeStateIssuer
300055631MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IN2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20210928002561 MI Practitioner - General Surgery 0345466009 Reassigns benefits to 1 organization
I20230911003377 IN Practitioner - General Surgery 0345466009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 2014
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
Suite 320
Elkhart, IN 46514-2477
Phone (574) 523-7900

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R-10033IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Oct 30, 2023 Accepting new patients
Promed Healthcare CurrentSince Oct 17, 2021 Accepting new patients
Beacon Medical Group Michigan Inc Surgery Current Accepting new patients
Beacon Medical Group Michigan Inc CurrentSince Oct 17, 2021 Accepting new patients
Beacon Medical Group, Inc. Surgery CurrentSince Oct 30, 2023 Accepting new patients

Locations

500 Arcade Ave
Ste 320
Elkhart, IN 46514
Phone (574) 293-3317

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

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

621 Memorial Dr
Ste 502
South Bend, IN 46601
Phone (574) 234-9001

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

1717 Shaffer St
Kalamazoo, MI 49048
Phone (269) 226-5050

1717 Shaffer St
Ste 002
Kalamazoo, MI 49048

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • Direct secure messaging: cfath22679@ukhcdirect.org

Organizations & group practices 6

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": "1402012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1811300817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 320",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142477",
            "telephone_number": "574-523-7900",
            "fax_number": "574-523-7909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "University Of Kentucky General Surgery 800 Rose St",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405361009",
            "country_code": "US",
            "telephone_number": "859-323-5860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "621 Memorial Dr",
            "address_2": "Suite 502",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011075",
            "country_code": "US",
            "telephone_number": "574-647-5875",
            "fax_number": "574-647-5878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FATH",
        "first_name": "COLIN",
        "middle_name": "TALANDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-06",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "R-10033",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "52660",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01091291A",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "KY",
            "license": "52660",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IN",
            "license": "01091291A",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "MI",
            "license": "4301505625",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300055631",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.