NPIMap

Individual provider Active NPI

Mark Paul Priebe, M.D.

  • Family Medicine Physician
  • Mishawaka, IN
National Provider Identifier
1831138684
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01041639 Issued in IN
Practice address
422 W McKinley Ave Ste B
Mishawaka, IN 46545-5522
Phone
(574) 666-2573
NPI assigned
Jun 6, 2006
Last updated
Aug 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01041639 IN Primary

Addresses

Primary practice location

422 W McKinley Ave Ste B
Mishawaka, IN 46545-5522

Mailing address

PO Box 746720
Atlanta, GA 30374-6720

Other practice location 1

17321 State Road 23
South Bend, IN 46635-1531
Phone (574) 272-7676

Other identifiers 1

IdentifierTypeStateIssuer
200045400AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100709000468 IN Practitioner - Family Practice 0749317121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1992
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Osh-in Physicians Group PCGroup PAC ID 6800100512, 62 clinicians

Practice addresses (Care Compare)

422 W McKinley Ave
Suite B
Mishawaka, IN 46545-5522
Phone (574) 666-2573

5926 Crawfordsville Rd
B
Speedway, IN 46224-3722
Phone (317) 653-2730

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01041639INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osh-in Physicians Group, PC Family Medicine CurrentSince Sep 4, 2023 Accepting new patients
Oak Street Health Physicians Group, PC Past Accepting new patients
Saint Joseph Regional Medical Center, Inc. Past Accepting new patients

Locations

422 W McKinley Ave
Mishawaka, IN 46545

422 W McKinley Ave
Ste B
Mishawaka, IN 46545
Phone (574) 666-2571

5926 Crawfordsville Rd
#B
Speedway, IN 46224
Phone (317) 653-2730

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1831138684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746720",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 W MCKINLEY AVE STE B",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465455522",
            "telephone_number": "574-666-2573"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17321 State Road 23",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466351531",
            "country_code": "US",
            "telephone_number": "574-272-7676",
            "fax_number": "574-272-7585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIEBE",
        "first_name": "MARK",
        "middle_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01041639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200045400A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.