MEMORIAL HOSPITAL OF SOUTH BEND, INC
NPI 1134534456
Physician Assistant in South Bend, IN
NPI Status: Active since June 25, 2014
Contact Information
403 E MADISON ST
SOUTH BEND, IN
ZIP 46617
Phone: (574) 647-8400
Fax: (574) 647-8410
- Organization
- Physician Assistant
- CLIA Number: 15D0920001
- CLIA Cert. Type: Hospital
- CLIA Exp. Date: 05-04-2028
About MEMORIAL HOSPITAL OF SOUTH BEND, INC
This page provides the complete NPI Profile along with additional information for Memorial Hospital Of South Bend, Inc, a primary care provider established in South Bend, Indiana operating as a Physician Assistant. The healthcare provider is registered in the NPI registry with number 1134534456 assigned on June 2014. The practitioner's primary taxonomy code is 363A00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Mr. Jeffery P Costello (Vp/cfo)
- NPI
- 1134534456
- Provider Name
- MEMORIAL HOSPITAL OF SOUTH BEND, INC
- Entity Type
- Organization
- Location Address
- 403 E MADISON ST SOUTH BEND, IN 46617
- Location Phone
- (574) 647-8400
- Location Fax
- (574) 647-8410
- Mailing Address
- 615 N MICHIGAN ST SOUTH BEND, IN 46601
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-25-2014
- Last Update Date
- 06-25-2014
- Code Navigator
A primary care provider (PCP) like Memorial Hospital Of South Bend, Inc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physician Assistant
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 282N00000X | Hospitals | General Acute Care Hospital |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 15D0920001
- Facility Type
- Hospital
- Certificate Effective Date
- May 05, 2026
- Certificate Expiration Date
- May 04, 2028
- Laboratory Director
- MICHELLE THOMPSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Memorial Hospital Of South Bend, Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1134534456, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 54. The final step is to find the difference between that total and the next multiple of ten (60 - 54 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 54 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
SOUTH BEND, IN 46617
SOUTH BEND, IN 46617
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1134534456, enumerated as an "organization" on June 25, 2014.
The provider is located at 403 E MADISON ST SOUTH BEND, IN 46617 and the phone number is (574) 647-8400.
Physician Assistant with taxonomy code 363A00000X.
