Individual provider Active NPI

Melissa Anne Hickey, M.D.

  • Pediatrics Physician
  • Granger, IN
National Provider Identifier
1902004872
Registry record updated Aug 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01068352A Issued in IN
Practice address
52500 Fir Rd
Granger, IN 46530-8579
Phone
(574) 271-0700
Fax
(574) 273-5648
NPI assigned
Jul 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01068352A IN Primary

Addresses

Primary practice location

52500 Fir Rd
Granger, IN 46530-8579

Mailing address

52500 Fir Rd
Granger, IN 46530-8579
Phone (574) 271-0700

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
I20140613001956 IN Practitioner - Pediatric Medicine 3678713559 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01068352AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic, LLC CurrentSince May 7, 2014 Accepting new patients
The South Bend Clinic LLC CurrentSince May 7, 2014 Accepting new patients
Logan Community Resources, Inc. PastSince Nov 1, 2018 Accepting new patients

Locations

52500 Fir Rd
Granger, IN 46530
Phone (574) 204-7050

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

Interoperability endpoints

  • Direct secure messaging: mhickey255844@dulyhealthandcare.direct-ci.com
  • FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

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.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470182400000",
    "number": "1902004872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52500 FIR RD",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308579",
            "telephone_number": "574-271-0700",
            "fax_number": "574-273-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52500 FIR RD",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308579",
            "telephone_number": "574-271-0700",
            "fax_number": "574-273-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKEY",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2016-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01068352A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

Verify at the official NPI Registry.