MICHIANA GASTROENTEROLOGY, INC - NPI 1821094525 - Internal Medicine in South Bend, IN

Q: What is the provider's specialty?

The provider's specialty is Internal Medicine with taxonomy code 207RG0100X and a focus in Gastroenterology.

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About Michiana Gastroenterology, Inc NPPES

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

MICHIANA GASTROENTEROLOGY, INC (NPI 1821094525) is a healthcare organization registered as a gastroenterology in South Bend, Indiana and active in the NPI registry since June 2005. The organization holds 2 active CLIA laboratory certificates and lists Melissa A Walker, Administrator, as its authorized official.

NPPES Registry Identity

NPI1821094525

Entity TypeOrganization

Primary Taxonomy207RG0100X

Legal Business NameMICHIANA GASTROENTEROLOGY, INC

Location Address17501 GENERATIONS DRSouth Bend, IN 46635-1589

Mailing Address17501 Generations DrSouth Bend, IN 46635-1589 · (574) 234-0049 · Fax (574) 251-2861

Phone(574) 234-0049

Fax(574) 251-2861

Organization SubpartNo

Authorized OfficialMelissa A WalkerAdministrator · (574) 234-0049

Enumeration DateJune 27, 2005

Last NPPES UpdateJuly 21, 2022

✔ NPI 1821094525 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians

Taxonomy Code207RG0100X

Definition

An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

17501 GENERATIONS DR, South Bend, IN 46635

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Other Identifiers 1

Medicaid100222490AIN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D0357333

Michiana Gastroenterology Inc · South Bend, IN

Active · expires Aug 31, 2026

CLIA Number15D0357333

Laboratory TypePhysician Office

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorJohn G. Mathis

Laboratory Phone(574) 234-0049

Laboratory LocationMichiana Gastroenterology Inc17501 Generations Dr, South Bend, IN 46635

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 15D2044025

Michiana Gastroenterology Laboratory · South Bend, IN

Active · expires Oct 29, 2026

CLIA Number15D2044025

Laboratory TypePhysician Office

Certificate Effective DateOctober 30, 2024

Certificate Expiration DateOctober 29, 2026

Laboratory DirectorAshley Obannon

Laboratory Phone(574) 245-7979

Laboratory LocationMichiana Gastroenterology Laboratory53830 Generations Drive, Ste 105, South Bend, IN 46635

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 11

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

DR. JOHN GLENN MATHIS M.D.

Internal Medicine (Gastroenterology)