John M Decelles, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

01051161 Issued in IN

Practice address

611 E Douglas Rd
Suite 309
Mishawaka, IN 46545-1467

Phone

(574) 472-6450

Fax

(574) 472-6474

NPI assigned

Jun 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Saint Joseph Regional Medical Center, Inc.

  • Pulmonary Disease Physician
  • Plymouth, IN
  • NPI 1225082878

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259884800000",
    "number": "1841238490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6309",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466606309",
            "telephone_number": "574-472-6700",
            "fax_number": "574-472-6746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD",
            "address_2": "SUITE 309",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451467",
            "telephone_number": "574-472-6450",
            "fax_number": "574-472-6474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECELLES",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2009-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01051161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000215219",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200228210A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "021236800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darryl Deal
• Shermiah Dean
• Dale Dennis Deardorff, M.D.
• Deborah Kriegel LLC
• Laura Decastor, MD
• Lindsey A. Decicco, PTA
• Kurtis Dejong, MD
• Del Pilar Medical & Urgent Care PC
• Arnold Del Pilar Jr., D.O.
• Kimberly D Delcourt, MSW, LCSW

• Internal Medicine Physician in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.