Individual provider Active NPI

Jonathan Wade Weiss, M.D.

  • Diagnostic Radiology Physician
  • Mishawaka, IN
National Provider Identifier
1881779700
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
47571-020 Issued in WI
Practice address
620 W Edison Rd
Suite 110
Mishawaka, IN 46545-2784
Phone
(574) 258-1100
Fax
(574) 258-1101
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 47571-020 WI Primary
Nuclear Radiology Physician 2085N0904X 01065200A IN

Addresses

Primary practice location

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

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
200949650MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20090623000642 IN Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 4385795897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Nuclear Medicine
Education
Indiana University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology IncGroup PAC ID 5890695464, 35 clinicians

Practice addresses (Care Compare)

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

15792 Ashville LN
Granger, IN 46530-6529
Phone (574) 258-1100

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

303 S Nappanee St
Elkhart Clinic
Elkhart, IN 46514-2066
Phone (574) 296-3365

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

Hospital & facility affiliations

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01065200AINMDNuclear Radiology Physician
47571-020WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Aug 8, 2022 Accepting new patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Mar 23, 2026 Accepting new patients
Radiology, Inc Nuclear Radiology CurrentSince Jul 1, 2009 Accepting new patients

Locations

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

303 S Nappanee St
Elkhart, IN 46514

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

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

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

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

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

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1881779700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD",
            "address_2": "SUITE 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": "SUITE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100",
            "fax_number": "574-258-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISS",
        "first_name": "JONATHAN",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "47571-020",
            "primary": true
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "IN",
            "license": "01065200A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200949650",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.