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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

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: July 19, 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
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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 Home State Health, Ambetter from Sunflower Health Plan, 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 (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.

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

What is Jack Staddon's NPI number?

The NPI number assigned to this healthcare provider is 1952500415, enumerated as an "individual" on July 15, 2007.

Where is the provider located?

The provider is located at 615 N MICHIGAN ST FL 4 SOUTH BEND, IN 46601 and the phone number is (574) 647-6892.

What is the provider's specialty?

Pediatrics with taxonomy code 2080P0207X and a focus in Pediatric Hematology-Oncology.

What insurance does Jack Staddon accept?

The provider might be accepting Accepts: Ambetter from Home State Health, Ambetter from. Please consult your insurance carrier or call the provider to verify.