Individual provider Active NPI

Ashley Anne Williamson, DO

  • Family Medicine Physician
  • South Bend, IN
National Provider Identifier
1992434831
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02008488A Issued in IN
Practice address
714 N Michigan St
South Bend, IN 46601-1035
Phone
(574) 647-7477
NPI assigned
Jun 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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 02008488A IN Primary

Addresses

Primary practice location

714 N Michigan St
South Bend, IN 46601-1035

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
300062539MedicaidIN

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
I20250716000908 IN Practitioner - Family Practice 1850770389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rocky Vista University College of Osteopathic Med, 2022
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)

714 N Michigan St
Beacon Medical Group E Blair Warner
South Bend, IN 46601-1035
Phone (574) 647-7477

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Jul 21, 2025 Accepting new patients
Beacon Medical Group, Inc. Family Medicine Current Accepting new patients
Beacon Medical Group, Inc. Family Medicine CurrentSince Jul 21, 2025 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

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

714 N Michigan St
South Bend, IN 46601
Phone (574) 647-7477

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 and National Provider Directory roles.

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": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1992434831",
    "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": "714 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011035",
            "telephone_number": "574-647-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "ASHLEY",
        "middle_name": "ANNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02008488A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300062539",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.