Michelle I Cervin -Wagner, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02001685 Issued in IN

Practice address

320 S Dr Martin Luther King Jr Blvd Ste 300
South Bend, IN 46601-2358

Phone

(574) 406-6376

Fax

(574) 406-6377

NPI assigned

Jul 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michelle I Cervin Other name

Medicare fee-for-service enrollment

Enrolled in MI

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 Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michelle.cervin-wagner.1@14940.direct.athenahealth.com

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.

• Three Rivers Health System, Inc

  • Rural Health Clinic/Center
  • White Pigeon, MI
  • NPI 1720350903
  Medicare reassignment NPD
• Everside Health, LLC

  • Primary Care Clinic/Center
  • South Bend, IN
  • NPI 1609232321
  NPD
• Three Rivers Health System, Inc

  • Infectious Disease Physician
  • Three Rivers, MI
  • NPI 1346874070
  NPD
• Three Rivers Health System, Inc

  • General Acute Care Hospital
  • Three Rivers, MI
  • NPI 1568739423
  NPD
• Everside Health LLC

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1952071110
  NPD (past)
• Everside Health, LLC

  • Clinic/Center
  • South Bend, IN
  • NPI 1497306310
  NPD (past)
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1780766261
  NPD (past)
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  NPD (past)
• Saint Joseph Regional Medical Center, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1467406074
  NPD (past)
• Air Angels Inc

  • Air Ambulance
  • West Chicago, IL
  • NPI 1316949951
  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1891711362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14504 DOUGLAS RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451709",
            "telephone_number": "574-344-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S DR MARTIN LUTHER KING JR BLVD STE 300",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466012358",
            "telephone_number": "574-406-6376",
            "fax_number": "574-406-6377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERVIN -WAGNER",
        "first_name": "MICHELLE",
        "middle_name": "I",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-15",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101011099",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891711362",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "CERVIN",
            "middle_name": "I",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Center for Positive Change, Inc
• Center for Positive Change, Inc
• Center for Positive Change, Inc.
• Center for Sleep and Nasal Sinus Disorders, LLC
• Central Indiana Orthopedics, LLC
• Adiba Chaddher
• Jon Blake Chadwell, M.D.
• Camden Chaffee
• Chalet of Hastings LLC
• Connie Marie Chalko, R.PH., C.M.C.

• Family Medicine Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.