NPIMap

Organization Active NPI

Indiana University South Bend Health & Wellness Center

  • Internal Medicine Physician
  • South Bend, IN
National Provider Identifier
1952721185
Registry record updated Apr 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01046709 Issued in IN
Legal business name
INDIANA UNIVERSITY SOUTH BEND HEALTH & WELLNESS CENTER
Practice address
941 20TH Street
South Bend, IN 46634-7111
Phone
(574) 520-5557
Fax
(574) 520-5042
NPI assigned
Apr 28, 2014
Last updated
Apr 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2014

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

Authorized official

Name
Mario Ortiz, RN; PHD; PHCNS-BCNPI 1265826226
Title
Dean and Professor
Phone
(574) 520-5557

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X NU
Licensed Practical Nurse 164W00000X 28076706A IN
Licensed Practical Nurse 164W00000X 28156667A IN
Internal Medicine Physician 207R00000X 01046709 IN Primary

Addresses

Primary practice location

941 20TH Street
South Bend, IN 46634-7111

Mailing address

941 20TH Street
South Bend, IN 46634-7111
Phone (574) 520-5557

National Provider Directory

National Provider Directory
Tax ID family
Atwater Eye Care Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1952721185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 20TH STREET",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466347111",
            "telephone_number": "574-520-5557",
            "fax_number": "574-520-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 20TH STREET",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466347111",
            "telephone_number": "574-520-5557",
            "fax_number": "574-520-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY SOUTH BEND HEALTH & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-28",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "ORTIZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "DEAN AND PROFESSOR",
        "authorized_official_telephone_number": "574-520-5557",
        "authorized_official_credential": "RN; PHD; PHCNS-BC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IN",
            "license": "28076706A",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IN",
            "license": "28156667A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01046709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.