Jack Staddon, M.D., PH.D.

Primary specialty

Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X

License

04-45815 Issued in KS

Practice address

615 N Michigan St FL 4
South Bend, IN 46601-1033

Phone

(574) 647-6892

Fax

(574) 647-6895

NPI assigned

Jul 15, 2007

Last updated

Jul 2, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.staddon@hca3.eclinicaldirectplus.com

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.

• University of Kansas School of Medicine Wichita Medical Practice Assoc

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1639143712
  Medicare reassignment NPD
• Wesley Physicians Medical Specialties LLC

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1699069732
  Medicare reassignment NPD
• Beacon Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • South Bend, IN
  • NPI 1831149525
  NPD (past)
• Beacon Medical Group, Inc.

  dba Beacon Medical Group Pediatric Hematology Oncology

  • Pediatric Hematology & Oncology Physician
  • South Bend, IN
  • NPI 1992756696

  Pediatric Hematology-Oncology

  NPD (past)
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

{
    "created_epoch": "1184457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1952500415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "telephone_number": "574-647-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST FL 4",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-6892",
            "fax_number": "574-647-6895"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3243 E Murdock St Ste 510",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672083007",
            "country_code": "US",
            "telephone_number": "316-962-3928",
            "fax_number": "316-962-3930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STADDON",
        "first_name": "JACK",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-15",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "IN",
            "license": "01099630A",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "KS",
            "license": "04-45815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300132256",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Joseph County Auditor (St. Joseph County Health Department)
• Susan M St. Ville, PH.D., MSW, LCSW
• Christine F Stacey, LCSW
• Diane M Stacker, O.T.
• Samantha Morgan Stacy
• Kaleigh Renee Stafford
• Cheryl Ann Stahl, FNP-BC
• Madelyn Stahl, RPH
• Alec Thomas Staiger, DO
• Alyssa Stair, RBT

• Pediatric Hematology & Oncology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Pediatric Hematology & Oncology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.