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JACK STADDON M.D., PH.D.
NPI 1952500415
Pediatrics - Pediatric Hematology-Oncology in South Bend, IN

Active since July 15, 2007PECOS Enrolled
615 N MICHIGAN ST FL 4, SOUTH BEND, IN 46601(574) 647-6892(574) 647-6895 Get Directions Write a Review

NPPES record last updated: July 2, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 26, 2022, Feb 22, 2022, Apr 22, 2019 (3 updates tracked since 2019).

About Jack Staddon M.d., Ph.d. NPPES

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

JACK STADDON M.D., PH.D. (NPI 1952500415) is an individual pediatric hematology-oncology provider in South Bend, Indiana, licensed in Kansas (04-45815) and active in the NPI registry since July 2007. He is enrolled in Medicare PECOS and maintains a secondary practice location in Wichita.

NPPES Registry Identity

NPI1952500415
Entity TypeIndividualMale
Primary Taxonomy2080P0207X
Provider Legal NameJACK STADDONCredential: M.D., PH.D.
Location Address615 N MICHIGAN ST FL 4South Bend, IN 46601-1033
Mailing Address3245 Health Dr Ste 100Granger, IN 46530-1380 · (574) 647-3725
Phone(574) 647-6892
Fax(574) 647-6895
Sole ProprietorNo
Enumeration DateJuly 15, 2007
Last NPPES UpdateJuly 2, 20263 updates tracked since enumeration
NPPES CertifiedJuly 2, 2026
✔ NPI 1952500415 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Pediatric Hematology-OncologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0207X
Licenses✔ Licensed in KS · 04-45815✔ Licensed in IN · 01099630A
Definition
A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases.
615 N MICHIGAN ST FL 4, South Bend, IN 46601
Open in Google Maps ↗

Secondary Practice Location 1

Location 13243 E Murdock St Ste 510Wichita, KS 67208-3007 · Phone (316) 962-3928 · Fax (316) 962-3930

Other Identifiers 1

Medicaid300132256IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Sunflower Health Plan, Ambetter Health, Ambetter Health of Delaware 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 (PECOS)

Jack Staddon M.d., Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignments

2

Medicare enrollment records show Jack Staddon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Wesley Physicians Medical Specialties LLC
641 mi
Internal Medicine
2600 N WOODLAWN BLVD
Wichita, KS 67220
  • Reassigned Medicare billing, Kansas enrollment
  • 136 clinicians in this Medicare group
NPI 1699069732 (316) 260-1690
University Of Kansas School Of Medicine Wichita Medical Practice Assoc
645 mi
Internal Medicine
1001 N MINNEAPOLIS
Wichita, KS 67214
  • Reassigned Medicare billing, Kansas enrollment
  • 130 clinicians in this Medicare group
NPI 1639143712 (316) 293-2620

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

Other Providers at the Same Location NPPES

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

TRACI RENEE PULLIAM DNP
Nurse Practitioner (Family)
615 N MICHIGAN ST FL 4
SOUTH BEND, IN 46601
St. Joseph County (574) 647-6892

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 Jack Staddon's NPI number?

The NPI number for Jack Staddon is 1952500415. It was assigned to this individual provider in the NPPES registry on July 15, 2007.

Where is Jack Staddon located?

Jack Staddon practices at 615 N Michigan St Fl 4, South Bend, IN 46601. The listed phone number is (574) 647-6892.

What is Jack Staddon's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Hematology-Oncology, with taxonomy code 2080P0207X.

Is Jack Staddon enrolled in Medicare?

Yes. Jack Staddon is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Jack Staddon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Staddon reassigns Medicare benefits to 2 organizations: Wesley Physicians Medical Specialties LLC (Wichita, KS) and University Of Kansas School Of Medicine Wichita Medical Practice Assoc (Wichita, KS). Each 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 Jack Staddon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Staddon accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Ambetter of Oklahoma and Anthem Blue Cross and Blue Shield and 1 other insurer list Jack Staddon 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 Jack Staddon was last updated on July 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.