Jack Staddon, MD, PHD in South Bend, IN

Jack Staddon, MD, PHD is a medicare enrolled "Pediatrics - Pediatric Hematology-oncology" physician in South Bend, Indiana. His current practice location is 615 N Michigan St Fl 4, South Bend, Indiana. You can reach out to his office (for appointments etc.) via phone at (574) 647-6892.

Jack Staddon is licensed to practice in Kansas (license number 04-45815) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1952500415.

Contact Information

	Jack Staddon, MD, PHD
	615 N Michigan St Fl 4, South Bend, IN 46601-1033
	(574) 647-6892
	(574) 647-6895

Map and Direction

Physician's Profile

Full Name	Jack Staddon
Gender	Male
Speciality	Pediatrics - Pediatric Hematology-oncology
Location	615 N Michigan St Fl 4, South Bend, Indiana
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1952500415
Provider Enumeration Date: 07/15/2007
Last Update Date: 07/02/2026

Medicare PECOS Information:

PECOS PAC ID: 8921230772
Enrollment ID: I20220912000367

Medical Identifiers

Medical identifiers for Jack Staddon such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1952500415	NPI	-	NPPES
300132256	Medicaid	IN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2080P0207X	Pediatrics - Pediatric Hematology-oncology	01099630A (Indiana)	Secondary
2080P0207X	Pediatrics - Pediatric Hematology-oncology	04-45815 (Kansas)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jack Staddon allows following entities to bill medicare on his behalf.

Entity Name	University Of Kansas School Of Medicine Wichita Medical Practice Assoc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1639143712 PECOS PAC ID: 3577464841 Enrollment ID: O20040119000674

Entity Name	Wesley Physicians Medical Specialties Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1699069732 PECOS PAC ID: 1355509886 Enrollment ID: O20120229000737

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack Staddon is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jack Staddon, MD, PHD 3245 Health Dr Ste 100, Granger, IN 46530-1380 Ph: (574) 647-3725	Jack Staddon, MD, PHD 615 N Michigan St Fl 4, South Bend, IN 46601-1033 Ph: (574) 647-6892

Reviews and Comments

Pediatrics Doctors in South Bend, IN

Angela C Herman, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 615 N Michigan St, 4th Fl, South Bend, IN 46601 Phone: 574-647-6892 Fax: 574-647-6895
Asad Ansari, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 100 Navarre Pl Ste 5550, South Bend, IN 46601 Phone: 574-647-2550 Fax: 574-647-1129
Megan Elizabeth Conway, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 615 N Michigan St, 5th Fl, South Bend, IN 46601 Phone: 574-647-7275 Fax: 574-647-3696
Desire M Andersen, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 615 N Michigan St Fl 5, South Bend, IN 46601 Phone: 574-647-7275 Fax: 574-647-3696
Dr. Lori A Wykoff, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 415 E Madison St, South Bend, IN 46617 Phone: 574-533-1234 Fax: 574-537-2652
Ruchita Kachru, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1815 E Ireland Rd, South Bend, IN 46614 Phone: 574-647-1700 Fax: 574-291-3351
Dr. Robert Dennis White, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 615 N Michigan St, South Bend, IN 46601 Phone: 574-647-7351 Fax: 574-647-7248

Jack Staddon, MD, PHD - Medicare Pediatrics in South Bend, IN