Individual provider Active NPI

Alexander Marcus Tawadros, MD

  • Diagnostic Radiology Physician
  • Mishawaka, IN
National Provider Identifier
1861694556
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01072421 Issued in IN
Practice address
620 W Edison Rd
Ste 110
Mishawaka, IN 46545-2784
Phone
(574) 258-1100
Fax
(574) 258-1101
NPI assigned
Jun 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301090011 MI
Diagnostic Radiology Physician 2085R0202X 01072421 IN Primary

Addresses

Primary practice location

620 W Edison Rd
Ste 110
Mishawaka, IN 46545-2784

Mailing address

620 W Edison Rd
Ste 110
Mishawaka, IN 46545-2784
Phone (574) 258-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 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
I20130717000677 IN Practitioner - Diagnostic Radiology 4688814551 Reassigns benefits to 1 organization
I20220830003442 MI Practitioner - Diagnostic Radiology 4688814551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology IncGroup PAC ID 5890695464, 35 clinicians

Practice addresses (Care Compare)

100 Navarre PL
Suite 5510
South Bend, IN 46601-1172
Phone (574) 647-7742

100 Navarre PL
Suite 6655
South Bend, IN 46601-1174
Phone (574) 647-6850

1010 W State Rd
Suite 2
La Porte, IN 46350-5465
Phone (574) 258-1100

1020 High Rd
Bremen, IN 46506-1093
Phone (574) 546-2211

1033 N Indiana Ave
Syracuse, IN 46567-1017
Phone (574) 457-5701

1115 Professional Dr
Goshen, IN 46526-3800
Phone (574) 364-4850

1135 Professional Dr
Goshen, IN 46526-3800
Phone (574) 364-4000

200 High Park Ave
Goshen, IN 46526-4810
Phone (574) 535-2693

2314 Creekview Dr
Mishawaka, IN 46545-7279
Phone (574) 258-1100

600 E Blvd
Elkhart, IN 46514-2483
Phone (574) 294-2621

615 N Michigan St
Memorial Hospital
South Bend, IN 46601-1033
Phone (574) 647-1000

6901 N Main St
Memorial Lighthouse Imaging Center
Granger, IN 46530-8022
Phone (574) 647-2900

701 S Health Pkwy
Three Rivers, MI 49093-8352
Phone (269) 278-1145

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Goshen Hospital Hospital, Goshen, IN, CCN 150026
  • Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300
  • Three Rivers Health Hospital, Three Rivers, MI, CCN 230015

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01072421INMDDiagnostic Radiology Physician
4301090011MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Aug 8, 2022 Accepting new patients
Radiology, Inc Diagnostic Radiology CurrentSince Jun 15, 2013 Accepting new patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Mar 23, 2026 Accepting new patients

Locations

1020 High Rd
#O
Bremen, IN 46506
Phone (574) 284-3086

600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621

303 S Nappanee St
Elkhart, IN 46514

1135 Professional Dr
Goshen, IN 46526
Phone (574) 364-4600

2222 Rieth Blvd
Ste 101
Goshen, IN 46526
Phone (574) 875-0881

200 High Park Ave
Goshen, IN 46526
Phone (219) 533-2141

1115 Professional Dr
Goshen, IN 46526
Phone (574) 364-4850

6901 N Main St
Granger, IN 46530
Phone (574) 647-2900

620 W Edison Rd
Ste 110
Mishawaka, IN 46545
Phone 5742581100 ext. 239

100 Navarre Pl
Ste 5500
South Bend, IN 46601
Phone (574) 647-5200

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

100 Navarre Pl
Ste 6655
South Bend, IN 46601
Phone (574) 284-6850

701 S Health Parkway
Three Rivers, MI 49093
Phone (269) 273-9691

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374451200000",
    "number": "1861694556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD",
            "address_2": "STE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100",
            "fax_number": "574-258-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD",
            "address_2": "STE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100",
            "fax_number": "574-258-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAWADROS",
        "first_name": "ALEXANDER",
        "middle_name": "MARCUS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-04",
        "last_updated": "2013-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301090011",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01072421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.