Active NPI
William P Buckley, M.D.
- Internal Medicine Physician
- Elkhart, IN
National Provider Identifier
1922001098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01044742A
- Practice address
- 303 S Nappanee St
Elkhart, IN 46514-2066 - Phone
- (574) 296-3314
- Fax
- (574) 296-3351
- NPI assigned
- May 23, 2005
- Last updated
- Aug 9, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01044742A | IN | Primary |
Addresses
Primary practice location
303 S Nappanee St
Elkhart, IN 46514-2066
Mailing address
PO Box 2968
Elkhart, IN 46515-2968
Phone (574) 296-3314
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200105920A | Medicaid | IN |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Indiana University School of Medicine, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2115 W Lexington Ave
Elkhart, IN 46514-1423
Phone (574) 296-3955
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 19 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01044742A | IN | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Indiana, LLC | Current | Accepting new patients | |
| Privia Medical Group Indiana, LLC | Current | Accepting new patients | |
| Pekin Prohealth Inc | Internal Medicine | Past | Accepting new patients |
Locations
2115 W Lexington Ave
Elkhart, IN 46514
Phone (574) 296-3437
303 S Nappanee St
Elkhart, IN 46514
Interoperability endpoints
- william.buckley.1@31626.direct.athenahealth.com
- william.buckley@elkhartc.eclinicaldirectplus.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Multi-Specialty Clinic/Center
- Elkhart, IN
- NPI 1013912286
-
- Family Nurse Practitioner
- Wakarusa, IN
- NPI 1568147809
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Granger, IN
- NPI 1679969489
-
- General Acute Care Hospital
- Elkhart, IN
- NPI 1477551489
-
- General Acute Care Hospital
- South Bend, IN
- NPI 1295772093
-
dba Memorial Epworth Center
- Psychiatric Hospital Unit
- South Bend, IN
- NPI 1376841395
-
dba Beacon Granger Hospital, A Memorial Hospital Extension
- General Acute Care Hospital
- Granger, IN
- NPI 1881177756
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281312000000",
"number": "1922001098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2968",
"city": "ELKHART",
"state": "IN",
"postal_code": "465152968",
"telephone_number": "574-296-3314",
"fax_number": "574-296-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 S NAPPANEE ST",
"city": "ELKHART",
"state": "IN",
"postal_code": "465142066",
"telephone_number": "574-296-3314",
"fax_number": "574-296-3351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "WILLIAM",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-23",
"last_updated": "2010-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01044742A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200105920A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; 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.