NPIMap

Individual provider Active NPI

Cynthia Lynn Pascual, M.D.

  • Family Medicine Physician
  • Granger, IN
National Provider Identifier
1962401091
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01054944A Issued in IN
Practice address
12340 Bittersweet Commons Blvd W
Granger, IN 46530-6959
Phone
(574) 271-8610
Fax
(574) 271-8620
NPI assigned
Jul 20, 2005
Last updated
Jan 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301116513 MI
Family Medicine Physician 207Q00000X 01054944A IN Primary

Addresses

Primary practice location

12340 Bittersweet Commons Blvd W
Granger, IN 46530-6959

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 2

IdentifierTypeStateIssuer
200343500MedicaidIN
1962401091MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050201000543 IN Practitioner - Family Practice 9739130352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

12340 Bittersweet Commons Blvd W
Beacon Medical Group Bittersweet
Granger, IN 46530-6959
Phone (574) 271-8610

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01054944AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Beacon Medical Group, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Valley-Wide Health Systems, Inc. Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

12340 Bittersweet Commons Blvd W
Granger, IN 46530
Phone (574) 271-8610

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1962401091",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12340 BITTERSWEET COMMONS BLVD W",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465306959",
            "telephone_number": "574-271-8610",
            "fax_number": "574-271-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASCUAL",
        "first_name": "CYNTHIA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301116513",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01054944A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200343500",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962401091",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

Verify at the official NPI Registry.