MITCHELL DAUGHERTY
NPI 1417481540
Family Medicine - Sports Medicine in South Bend, IN

Q: What is Mitchell Daugherty's NPI number?

The NPI number for Mitchell Daugherty is 1417481540. It was assigned to this individual provider in the NPPES registry on April 14, 2017.

Q: What is Mitchell Daugherty's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Active since April 14, 2017PECOS EnrolledAccepts Medicare Assignment

1815 E IRELAND RD, SOUTH BEND, IN 46614(574) 647-1700(574) 647-7572 Get Directions Write a Review

NPPES record last updated: June 20, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 20, 2025, Sep 30, 2024, Aug 19, 2022 and 4 more (7 updates tracked since 2017).

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About Mitchell Daugherty NPPES

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

MITCHELL DAUGHERTY (NPI 1417481540) is an individual sports medicine provider in South Bend, Indiana, licensed in Indiana (01082368A) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS, is affiliated with Memorial Hospital Of South Bend, and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1417481540

Entity TypeIndividualMale

Primary Taxonomy207QS0010X

Provider Legal NameMITCHELL DAUGHERTY

Location Address1815 E IRELAND RDSouth Bend, IN 46614-2845

Mailing Address710 N Niles AveSouth Bend, IN 46617-1924 · (574) 647-1610

Phone(574) 647-1700

Fax(574) 647-7572

Sole ProprietorNo

Medical School CMSUniversity Of Illinois College Of Med (chi/peor/rock/chm-urb)Graduated 2017

Enumeration DateApril 14, 2017

Last NPPES UpdateJune 20, 20257 updates tracked since enumeration

NPPES CertifiedJune 20, 2025

✔ NPI 1417481540 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QS0010X

License✔ Licensed in IN · 01082368A

Definition

A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

Also ListedFamily MedicineTaxonomy 207Q00000X · License 01082368A (IN)

1815 E IRELAND RD, South Bend, IN 46614

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Secondary Practice Locations 4

Location 1100 Navarre Pl Ste 4440South Bend, IN 46601-1171 · Phone (574) 647-5300

Location 2714 N Michigan StSouth Bend, IN 46601-1035 · Phone (574) 647-7477 · Fax (574) 647-3655

Location 3900 I StLA Porte, IN 46350-5533 · Phone (219) 324-1700 · Fax (219) 324-1602

Location 4111 W Jefferson Blvd Ste 100South Bend, IN 46601-1993 · Phone (574) 647-1670 · Fax (574) 647-6927

Other Identifiers 1

Medicaid300003172IN

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, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mitchell Daugherty 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 ID9638447238

PECOS Enrollment IDI20210819003594

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.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

459 services67 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

141 services104 patients

Aspiration and/or injection of fluid large joint using ultrasound guidance 20611

This procedure involves using ultrasound technology to accurately locate a large joint, usually the knee or shoulder. A needle is then inserted to either extract fluid (aspiration) or inject medication. The ultrasound helps ensure precision and safety.

115 services70 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

89 services70 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

43 services43 patients

X-ray of shoulder, minimum of 2 views 73030

An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.

21 services20 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Memorial Hospital Of South Bend

Acute Care Hospitals · South Bend, IN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number150058

Location615 N Michigan StSouth Bend, IN 46601 · St. Joseph County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46614 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.

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Other Providers at the Same Location NPPES 20

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

DR. TRAVIS WEAVER D.O.

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