Pediatric Cardiology of Michiana, PC

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

01034696A Issued in IN

Legal business name

PEDIATRIC CARDIOLOGY OF MICHIANA, PC

Practice address

707 N Michigan St
Suite 316
South Bend, IN 46601-1067

Phone

(574) 232-3325

Fax

(574) 232-3358

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Stacy Speckhard

Title

Office Manager

Phone

(574) 232-3325

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1891816559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N MICHIGAN ST",
            "address_2": "SUITE 316",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011067",
            "telephone_number": "574-232-3325",
            "fax_number": "574-232-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N MICHIGAN ST",
            "address_2": "SUITE 316",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011067",
            "telephone_number": "574-232-3325",
            "fax_number": "574-232-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARDIOLOGY OF MICHIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "SPECKHARD",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "574-232-3325",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "IN",
            "license": "01034696A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100475760A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4564274",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IN",
            "identifier": "000000330797001",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1761550",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lynn Pearson, M.D.
• Richard B Pearson
• Daniel J Peck, MSW
• Thomas Pedavoli, DDS
• Kelly Peddy, PHARMD, MPA, BCACP
• Pediatrix Medical Group of Indiana, PC
• Sheree L. Peglow, M.D.
• Jeniffer Pena-Alvarez, MSW
• Emerald Ily Mae Penley, RN
• Erin Nicole Pennington, BA

• Pediatric Cardiology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Pediatric Cardiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.