Active NPI
Virgil A Dibiase, M.D.
- Neurology Physician
- South Bend, IN
National Provider Identifier
1821024043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 01042651A
- Practice address
- 707 N Michigan St Ste 102
South Bend, IN 46601-1068 - Phone
- (574) 647-8542
- Fax
- (574) 647-8549
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 01042651A | IN | Primary |
Addresses
Primary practice location
707 N Michigan St Ste 102
South Bend, IN 46601-1068
Mailing address
PO Box 772988
Detroit, MI 48277-2988
Phone (574) 647-1610
Other practice location 1
900 I St
LA Porte, IN 46350-5533
Phone (219) 324-1700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M32727008 | Other | MEDICARE | |
| 100386310 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vadibiase@mybeacon.cernerdirect.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672963200000",
"number": "1821024043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 772988",
"city": "DETROIT",
"state": "MI",
"postal_code": "482772988",
"telephone_number": "574-647-1610",
"fax_number": "574-237-6069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 N MICHIGAN ST STE 102",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011068",
"telephone_number": "574-647-8542",
"fax_number": "574-647-8549"
}
],
"practiceLocations": [
{
"address_1": "900 I St",
"address_purpose": "LOCATION",
"city": "LA Porte",
"state": "IN",
"postal_code": "463505533",
"country_code": "US",
"telephone_number": "219-324-1700",
"fax_number": "219-324-1602",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DIBIASE",
"first_name": "VIRGIL",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2023-01-06",
"certification_date": "2023-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IN",
"license": "01042651A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "M32727008",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100386310",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "vadibiase@mybeacon.cernerdirect.com",
"affiliation": "N",
"address_1": "707 N Michigan St Ste 102",
"city": "South Bend",
"state": "IN",
"country_code": "US",
"postal_code": "466011068",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.