Individual provider Active NPI

Lacy Katowich, FNP

  • Family Nurse Practitioner
  • Mishawaka, IN
National Provider Identifier
1902421076
Registry record updated Apr 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F09201325 Issued in IN
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

Updated by the provider on Apr 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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 Professional name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230420000411 IN Practitioner - Nurse Practitioner 5698130904 Reassigns benefits to 1 organization

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
The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

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

LicenseStateTypeSpecialty
28151346AINMDRegistered Nurse
F09201325INMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic, LLC CurrentSince Mar 3, 2023 Accepting new patients
The South Bend Clinic LLC CurrentSince Mar 3, 2023 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

  • Direct secure messaging: lkatowich253935@dulyhealthandcare.direct-ci.com
  • FHIR API: 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.

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

Verify at the official NPI Registry.