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OLIVIA GRAYCE TACK M.D.
NPI 1255371514
Pediatrics in Granger, IN

Active since June 07, 2006PECOS EnrolledAccepts Medicare Assignment
6913 N MAIN ST STE 200, GRANGER, IN 46530(574) 647-4540(574) 647-2567 Get Directions Write a Review

NPPES record last updated: November 24, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 24, 2025, Apr 6, 2021, Nov 13, 2018 and 2 more (5 updates tracked since 2017).

About Olivia Grayce Tack M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OLIVIA GRAYCE TACK M.D. (NPI 1255371514) is an individual pediatrics provider in Granger, Indiana, licensed in Indiana (01062281A) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS and is a graduate of Michigan State University College Of Human Medicine (2003).

NPPES Registry Identity

NPI1255371514
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameOLIVIA GRAYCE TACKCredential: M.D.
Location Address6913 N MAIN ST STE 200Granger, IN 46530-8039
Mailing Address3245 Health Dr Ste 100Granger, IN 46530-1380 · (574) 647-2713
Phone(574) 647-4540
Fax(574) 647-2567
Sole ProprietorNo
Medical School CMSMichigan State University College Of Human MedicineGraduated 2003
Enumeration DateJune 7, 2006
Last NPPES UpdateNovember 24, 20255 updates tracked since enumeration
NPPES CertifiedNovember 24, 2025
✔ NPI 1255371514 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in IN · 01062281A
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
6913 N MAIN ST STE 200, Granger, IN 46530
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Other Names 1

Former Name (1)Olivia Grayce Fusillo Md

Other Identifiers 2

Other247000031IN · Medicare Ptan
Medicaid200828650IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Olivia Grayce Tack M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3173522786
PECOS Enrollment IDI20061208000372
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Olivia Tack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Beacon Medical Group, Inc.
Same address
Family Medicine
6913 N MAIN ST STE 300
Granger, IN 46530
  • Reassigned Medicare billing, Indiana enrollment
  • 734 clinicians in this Medicare group
NPI 1053361543 (574) 647-1500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46530 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.04 typical visit price
range $53.07 – $161.76
Typical copayment $20.51 (range $13.26 – $40.44)
Most-billed visit code 99203
Established Patient
$94.22 typical visit price
range $16.93 – $132.22
Typical copayment $23.55 (range $4.23 – $33.05)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SHANNA VERMA KAUTZMANN M.D.
Pediatrics
6913 N MAIN ST STE 200
GRANGER, IN 46530
St. Joseph County (574) 647-4540
MISS MADISON ASHLEY PARKER NP
Nurse Practitioner (Family)
6913 N MAIN ST STE 200
GRANGER, IN 46530
St. Joseph County (574) 647-4540
NANCY ANNE PUDLO MD
Pediatrics
6913 N MAIN ST STE 200
GRANGER, IN 46530
St. Joseph County (574) 647-4540
MS. SHERRI JO BIEVER FNP
Nurse Practitioner (Family)
6913 N MAIN ST STE 200
GRANGER, IN 46530
St. Joseph County (574) 647-4540

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Olivia Tack's NPI number?

The NPI number for Olivia Tack is 1255371514. It was assigned to this individual provider in the NPPES registry on June 7, 2006. The provider is also known as Olivia Grayce Fusillo MD.

Where is Olivia Tack located?

Olivia Tack practices at 6913 N Main St Ste 200, Granger, IN 46530. The listed phone number is (574) 647-4540.

What is Olivia Tack's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Olivia Tack enrolled in Medicare?

Yes. Olivia Tack is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Olivia Tack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Olivia Tack reassigns Medicare benefits to Beacon Medical Group, Inc. (Granger, IN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Olivia Tack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Olivia Tack accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Olivia Tack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Olivia Tack was last updated on November 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.