Active NPI
Lacy Katowich, FNP
- Family Nurse Practitioner
- Mishawaka, IN
National Provider Identifier
1902421076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F09201325
- Practice address
- 1802 Day Rd
Mishawaka, IN 46545-4329 - Phone
- (574) 204-7200
- NPI assigned
- Jun 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28151346A | IN | |
| Family Nurse Practitioner | 363LF0000X | F09201325 | IN | Primary |
Addresses
Primary practice location
1802 Day Rd
Mishawaka, IN 46545-4329
Mailing address
1802 Day Rd
Mishawaka, IN 46545-4329
Phone (572) 204-7200
Other names 1
- Mrs. Lacy L Katowich
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1802 Day Rd
Mishawaka, IN 46545-4329
Phone (574) 204-7200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28151346A | IN | MD | Registered Nurse |
| F09201325 | IN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The South Bend Clinic, LLC | Current | Accepting new patients | |
| The South Bend Clinic LLC | Current | Accepting new patients |
Locations
1802 Day Rd
Mishawaka, IN 46545
Phone (574) 204-7200
211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331
Interoperability endpoints
- lkatowich253935@dulyhealthandcare.direct-ci.com
- https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/
Organizations & group practices 2
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.
-
- Clinic/Center
- South Bend, IN
- NPI 1073680419
-
- Anesthesiology Physician
- South Bend, IN
- NPI 1487307492
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680825600000",
"number": "1902421076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1802 DAY RD",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465454329",
"telephone_number": "572-204-7200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1802 DAY RD",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465454329",
"telephone_number": "574-204-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KATOWICH",
"first_name": "LACY",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-14",
"last_updated": "2023-04-07",
"certification_date": "2023-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28151346A",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "F09201325",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LACY",
"last_name": "KATOWICH",
"middle_name": "L",
"prefix": "MRS.",
"credential": "FNP",
"code": "2",
"type": "Professional Name"
}
]
}
Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.