Individual provider Active NPI

Erin B Jungbauer, MD

  • Family Medicine Physician
  • Warsaw, IN
National Provider Identifier
1972546927
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01038535A Issued in IN
Practice address
1210 Provident Drive
Ste B
Warsaw, IN 46580
Phone
(574) 268-4300
NPI assigned
Jun 14, 2006
Last updated
Dec 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01038535A IN Primary

Addresses

Primary practice location

1210 Provident Drive
Ste B
Warsaw, IN 46580

Mailing address

6920 Pointe Inverness Way Ste 200
Fort Wayne, IN 46804-7934
Phone (260) 479-3513

Other identifiers 1

IdentifierTypeStateIssuer
100159270MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address erin.jungbauer@lutheranhealthnetwork.cernerdirect.com

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070613000387 IN Practitioner - Family Practice 7214035377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kosciusko Medical Group LLCGroup PAC ID 5496809956, 41 clinicians

Practice addresses (Care Compare)

1205 Provident Dr a
Warsaw, IN 46580-3265
Phone (574) 269-8383

1275 Provident Dr
Warsaw, IN 46580-3265
Phone (574) 269-4026

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01038535AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kosciusko Medical Group LLC Family Medicine CurrentSince Sep 1, 2009 Accepting new patients

Locations

6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514

1001 N Main St
Ste 1
Nappanee, IN 46550
Phone (574) 372-7637

1205 Provident Dr
#A
Warsaw, IN 46580
Phone (574) 269-8383

1210 Provident Dr
Warsaw, IN 46580
Phone (219) 268-4300

1210 Provident Dr
Ste B
Warsaw, IN 46580
Phone (574) 268-4300

Organizations & group practices 1

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 3

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1972546927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3513",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 PROVIDENT DRIVE",
            "address_2": "STE B",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "46580",
            "telephone_number": "574-268-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNGBAUER",
        "first_name": "ERIN",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01038535A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100159270",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "erin.jungbauer@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "1210 Provident Drive",
            "address_2": "Ste B",
            "city": "Warsaw",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warsaw, IN

Sources for this page

Verify at the official NPI Registry.