Individual provider Active NPI

Thomas Deverne Bussineau, D.O.

  • Internal Medicine Physician
  • South Bend, IN
National Provider Identifier
1992155055
Registry record updated Mar 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
02008147A Issued in IN
Practice address
615 N Michigan St 1St FL Hospitalist Ste
South Bend, IN 46601-1033
Phone
(574) 647-3050
Fax
(574) 647-1094
NPI assigned
Jun 20, 2016
Last updated
Mar 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 02008147A IN Primary
Hospitalist Physician 208M00000X 02008147A IN
Hospitalist Physician 208M00000X 5101025254 MI

Addresses

Primary practice location

615 N Michigan St 1St FL Hospitalist Ste
South Bend, IN 46601-1033

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-3725

Other practice location 1

600 East Blvd 4th Floor Hospitalists Ste
Elkhart, IN 46514-2483
Phone (574) 389-7393

Other practice location 2

50505 Schoenherr Rd Ste 340
Shelby Township, MI 48315-3140
Phone (586) 731-8400

Other identifiers 1

IdentifierTypeStateIssuer
300100592MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20191109000132 MI Practitioner - HospitalistPractitioner - Internal Medicine 7517250210 Reassigns benefits to 1 organization
I20241220000209 IN Practitioner - Internal Medicine 7517250210 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2016
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)

615 N Michigan St FL
1 Beacon Medical Group Hospital Spec
South Bend, IN 46601-1033
Phone (574) 647-3050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Beacon Medical Group Inc CurrentSince Feb 26, 2025 Accepting new patients
Seasons Hospice & Palliative Care of Indiana, LLC Family Medicine CurrentSince Sep 14, 2025 Accepting new patients
Great Lakes Medicine, PLC Internal Medicine CurrentSince Dec 1, 2019 Accepting new patients
Beacon Medical Group, Inc. Family Medicine CurrentSince Feb 26, 2025 Accepting new patients
Seasons Medical Group of Indiana, PC CurrentSince Sep 14, 2025 Accepting new patients
McLaren Macomb Past Accepting new patients

Locations

1746 Momentum Pl
Chicago, IL 60689

600 East Blvd
Fl 4
Elkhart, IN 46514
Phone (574) 389-7393

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

6640 Intech Blvd
Ste 270
Indianapolis, IN 46278
Phone (317) 885-4200

615 N Michigan St
Fl 1
South Bend, IN 46601
Phone (574) 647-1100

50505 Schoenherr Rd
Ste 340
Shelby Township, MI 48315
Phone (586) 731-8400

Interoperability endpoints

  • Direct secure messaging: tbussineau282706@direct.hfhs.org

Organizations & group practices 7

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 4

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": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774828800000",
    "number": "1992155055",
    "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 1ST FL HOSPITALIST STE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-3050",
            "fax_number": "574-647-1094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 East Blvd 4th Floor Hospitalists Ste",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142483",
            "country_code": "US",
            "telephone_number": "574-389-7393",
            "fax_number": "574-647-1094",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50505 Schoenherr Rd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Shelby Township",
            "state": "MI",
            "postal_code": "483153140",
            "country_code": "US",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSSINEAU",
        "first_name": "THOMAS",
        "middle_name": "DEVERNE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-20",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02008147A",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "02008147A",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "5101025254",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300100592",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.