MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
NPI 1912074659
Physical Medicine & Rehabilitation - Pain Medicine in Mishawaka, IN
NPI Status: Active since November 29, 2006
Contact Information
3740 EDISON LAKES PKWY
MISHAWAKA, IN
ZIP 46545
Phone: (574) 252-4150
Fax: (574) 252-4159
- Organization
- Physical Medicine & Rehabilitation
- Pain Medicine
- Accepts Insurance
- CLIA Number: 23D1104688
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-25-2026
About MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
This page provides the complete NPI Profile along with additional information for Michiana Spine, Sports & Occupational Rehab, Pc, a provider established in Mishawaka, Indiana operating as a Physical Medicine & Rehabilitation, focusing in pain medicine . The healthcare provider is registered in the NPI registry with number 1912074659 assigned on November 2006. The practitioner's primary taxonomy code is 2081P2900X with license number 01042863 (IN). The provider is registered as an organization and their NPI record was last updated 4 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. Kevin Gene Drew M.d. (President)
- NPI
- 1912074659
- Provider Name
- MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
- Entity Type
- Organization
- Location Address
- 3740 EDISON LAKES PKWY MISHAWAKA, IN 46545
- Location Phone
- (574) 252-4150
- Location Fax
- (574) 252-4159
- Mailing Address
- 3740 EDISON LAKES PKWY MISHAWAKA, IN 46545
- Mailing Phone
- (574) 252-4150
- Mailing Fax
- (574) 252-4159
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-29-2006
- Last Update Date
- 11-03-2022
- Code Navigator
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
Physical Medicine & Rehabilitation Pain Medicine
- Taxonomy Code
- 2081P2900X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 01042863
- License State
- IN
- Taxonomy Description
- A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Cross� Preferred HMO Bronze Extra - HMO
- Blue Cross� Preferred HMO Bronze Saver HSA - HMO
- Blue Cross� Preferred HMO Bronze Secure - HMO
- Blue Cross� Preferred HMO Gold - HMO
- Blue Cross� Preferred HMO Gold Extra - HMO
- Blue Cross� Preferred HMO Silver - HMO
- Blue Cross� Preferred HMO Silver Extra - HMO
- Blue Cross� Preferred HMO Silver Saver - HMO
- Blue Cross� Preferred HMO Value - HMO
- Blue Cross� Select HMO Bronze Extra - HMO
- Blue Cross� Premier PPO Bronze Extra - PPO
- Blue Cross� Premier PPO Bronze Saver HSA - PPO
- Blue Cross� Premier PPO Bronze Secure - PPO
- Blue Cross� Premier PPO Gold - PPO
- Blue Cross� Premier PPO Gold Extra - PPO
- Blue Cross� Premier PPO Silver - PPO
- Blue Cross� Premier PPO Silver Extra - PPO
- Blue Cross� Premier PPO Silver Saver HSA - PPO
- Blue Cross� Premier PPO Value - PPO
- Bronze 7500 $25 Generic Drugs - HMO
- Bronze 7500 $25 Generic Drugs + Adult Vision & Fitness - HMO
- Diabetes Gold 3000 $0 Chronic Care Drugs & Services - HMO
- Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Diabetes Silver 5000 $0 Chronic Care Drugs & Services - HMO
- Diabetes Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Gold 2000 $15 Generic Drugs - HMO
- Gold 2000 $15 Generic Drugs + Adult Vision & Fitness - HMO
- HDHP Preventive Silver 5500 $0 Chronic Care Drugs - HMO
- Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| CI5205 | OTHER (01) | RAILROAD MEDICARE | |
| 129646400 | OTHER (01) | DEPT OF LABORACS | |
| 200216220A | MEDICAID (05) | IN | |
| 25-0A110370 | OTHER (01) | MI | BCBSMI |
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
- 23D1104688
- Facility Type
- Physician Office
- Certificate Effective Date
- February 26, 2024
- Certificate Expiration Date
- February 25, 2026
- Laboratory Director
- JACQUELINE HURT
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Michiana Spine, Sports & Occupational Rehab, Pc on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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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 1912074659, we treat the final digit (9) 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 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
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 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 4 providers are registered at the same or a nearby location.
MISHAWAKA, IN 46545
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1912074659, enumerated as an "organization" on November 29, 2006.
The provider is located at 3740 EDISON LAKES PKWY MISHAWAKA, IN 46545 and the phone number is (574) 252-4150.
Physical Medicine & Rehabilitation with taxonomy code 2081P2900X and a focus in Pain Medicine.
The provider might be accepting Accepts: Blue Care Network of Michigan, Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.
