| Saint Joseph Regional Medical Center- Plymouth Campus Inc | |
|
1919 Lake Ave Ste 102b Plymouth IN 46563-7830 | |
| (574) 335-6800 | |
| (574) 948-5480 |
| Full Name | Saint Joseph Regional Medical Center- Plymouth Campus Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1919 Lake Ave Ste 102b, Plymouth, Indiana |
| Authorized Official Name and Position | Christopher James Karam (PRESIDENT) |
| Authorized Official Contact | 5743355000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint Joseph Regional Medical Center- Plymouth Campus Inc 5215 Holy Cross Parkway Saint Joseph Provider Services Mishawaka IN 46545-1469 Ph: (574) 335-8707 | Saint Joseph Regional Medical Center- Plymouth Campus Inc 1919 Lake Ave Ste 102b Plymouth IN 46563-7830 Ph: (574) 335-6800 |
| NPI Number | 1538585187 |
|---|---|
| Provider Enumeration Date | 03/06/2014 |
| Last Update Date | 04/15/2025 |
| Medicare PECOS PAC ID | 9537071337 |
|---|---|
| Medicare Enrollment ID | O20031223000588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538585187 | NPI | - | NPPES |
| 000000875287 | Other | IN | BCBS |
| 201216910A | Medicaid | IN | |
| 300036720 | Medicaid | IN |
| Provider Name | Douglas S Kuehn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1730132051 PECOS PAC ID: 6709790256 Enrollment ID: I20040225000104 |
| Provider Name | Timothy S Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952357287 PECOS PAC ID: 7214841766 Enrollment ID: I20040312000359 |
| Provider Name | Steven Gerstler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174579502 PECOS PAC ID: 5092788414 Enrollment ID: I20040814000122 |
| Provider Name | Edward Yang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477509156 PECOS PAC ID: 0143295311 Enrollment ID: I20040831000991 |
| Provider Name | Ajazuddin Z Shaikh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225032626 PECOS PAC ID: 9234020801 Enrollment ID: I20041002000133 |
| Provider Name | Richard L Dobben |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447252184 PECOS PAC ID: 5395631980 Enrollment ID: I20041215000465 |
| Provider Name | Vu Nguyen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073569729 PECOS PAC ID: 4082695770 Enrollment ID: I20050126000143 |
| Provider Name | John T Taylor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891891156 PECOS PAC ID: 0840360129 Enrollment ID: I20080529000147 |
| Provider Name | Jason R Grove |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1609040088 PECOS PAC ID: 4183791494 Enrollment ID: I20080927000183 |
| Provider Name | Abdul M Malik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952300584 PECOS PAC ID: 7315002979 Enrollment ID: I20090213000292 |
| Provider Name | Janet Galanes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235178856 PECOS PAC ID: 4486708930 Enrollment ID: I20090818000329 |
| Provider Name | Douglas R Liepert |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1083675011 PECOS PAC ID: 1850372541 Enrollment ID: I20100805000286 |
| Provider Name | Mark A Muckway |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265521652 PECOS PAC ID: 6305039454 Enrollment ID: I20101021000106 |
| Provider Name | Zubair Ul Haq |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518005198 PECOS PAC ID: 9133313042 Enrollment ID: I20101104000030 |
| Provider Name | Stephen M Simons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881776359 PECOS PAC ID: 5799974184 Enrollment ID: I20110118000091 |
| Provider Name | Rebecca Brice |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235245002 PECOS PAC ID: 3072510908 Enrollment ID: I20110207000412 |
| Provider Name | Anita L Flohe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497058580 PECOS PAC ID: 9931380235 Enrollment ID: I20110218001021 |
| Provider Name | Linda L Tuthill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376599522 PECOS PAC ID: 7113831660 Enrollment ID: I20110411000610 |
| Provider Name | Eric Knapp |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1700090602 PECOS PAC ID: 7315078490 Enrollment ID: I20110801000723 |
| Provider Name | Terrence D Wilkin |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1982656963 PECOS PAC ID: 0941228340 Enrollment ID: I20120216000182 |
| Provider Name | Jessica G Glassman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992054183 PECOS PAC ID: 9032362280 Enrollment ID: I20130122000030 |
| Provider Name | Kimberley K Mendez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043555394 PECOS PAC ID: 7012161946 Enrollment ID: I20130131000189 |
| Provider Name | Can Talug |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1972708535 PECOS PAC ID: 9830243708 Enrollment ID: I20130225000403 |
| Provider Name | Mohammed Omar Jahangir |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073748422 PECOS PAC ID: 1456526813 Enrollment ID: I20130720000130 |
| Provider Name | Asad Kizilbash |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861630907 PECOS PAC ID: 1254485535 Enrollment ID: I20130809000091 |
| Provider Name | Jonathan M Mccrea |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700048923 PECOS PAC ID: 0345499505 Enrollment ID: I20130905000648 |
| Provider Name | Zachary Leshen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285646729 PECOS PAC ID: 8628139367 Enrollment ID: I20130912000734 |
| Provider Name | Laura E Blackford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073892428 PECOS PAC ID: 2567686819 Enrollment ID: I20140917003050 |
| Provider Name | Tabitha M Pollard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891194981 PECOS PAC ID: 0840412805 Enrollment ID: I20141107000871 |
| Provider Name | Christopher C Jordan |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1689938664 PECOS PAC ID: 7012156060 Enrollment ID: I20141231000156 |
| Provider Name | Kathryn Zehr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144601808 PECOS PAC ID: 8426366386 Enrollment ID: I20150928000277 |
| Provider Name | Steve Sikorevich |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447489125 PECOS PAC ID: 7012158041 Enrollment ID: I20151216001558 |
| Provider Name | Peter Miller |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1295991081 PECOS PAC ID: 1850537697 Enrollment ID: I20160526001186 |
| Provider Name | Sohaib Aleem |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1588894026 PECOS PAC ID: 7012188543 Enrollment ID: I20160617000277 |
| Provider Name | Justin M Leugers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679922355 PECOS PAC ID: 7113210568 Enrollment ID: I20160722002353 |
| Provider Name | Aimee Lee Clady |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902345879 PECOS PAC ID: 4688951312 Enrollment ID: I20170508000948 |
| Provider Name | Nabil A Khan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1841579406 PECOS PAC ID: 6204059546 Enrollment ID: I20170926001059 |
| Provider Name | Neha Sharma |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1750541892 PECOS PAC ID: 9032365713 Enrollment ID: I20180629000700 |
| Provider Name | Qussai Salamah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447554654 PECOS PAC ID: 5294904462 Enrollment ID: I20181220003361 |
| Provider Name | Mahmud Zamlut |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1952579542 PECOS PAC ID: 4688740384 Enrollment ID: I20190109002457 |
| Provider Name | Marla M Troyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114482676 PECOS PAC ID: 8921348285 Enrollment ID: I20190322001523 |
| Provider Name | Laura Satka Gettler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114499654 PECOS PAC ID: 1658612684 Enrollment ID: I20190401001017 |
| Provider Name | Jeremy L Gunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285198150 PECOS PAC ID: 0547502775 Enrollment ID: I20190508001605 |
| Provider Name | Donald R Westerhausen |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437491974 PECOS PAC ID: 4688977515 Enrollment ID: I20190522002386 |
| Provider Name | Daniel Nwankwo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1639526007 PECOS PAC ID: 2860735248 Enrollment ID: I20190529000434 |
| Provider Name | Anna N Matulewicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184966681 PECOS PAC ID: 3072749449 Enrollment ID: I20190611001203 |
| Provider Name | Benjamin Cale Friesen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366905275 PECOS PAC ID: 0840524179 Enrollment ID: I20190620001091 |
| Provider Name | Muhammad M Mufti |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1215396148 PECOS PAC ID: 3173851854 Enrollment ID: I20190912000393 |
| Provider Name | Syed Raza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578737219 PECOS PAC ID: 3577788199 Enrollment ID: I20190918003100 |
| Provider Name | Tarek Saleh |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1790915544 PECOS PAC ID: 5597915959 Enrollment ID: I20200422001851 |
| Provider Name | Apeksha R Shah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992324883 PECOS PAC ID: 4880018795 Enrollment ID: I20200724002078 |
| Provider Name | Sabeen Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902330988 PECOS PAC ID: 4587083357 Enrollment ID: I20200928002107 |
| Provider Name | Iryna Vitaliyivna Polyakova |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447633326 PECOS PAC ID: 1759638430 Enrollment ID: I20201002000088 |
| Provider Name | Harsha Nagarajarao |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548471311 PECOS PAC ID: 8022235605 Enrollment ID: I20201009000915 |
| Provider Name | Cecilia M Maina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023640117 PECOS PAC ID: 6709206253 Enrollment ID: I20201021003003 |
| Provider Name | Frank Addo |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679592828 PECOS PAC ID: 0042215592 Enrollment ID: I20201125001501 |
| Provider Name | Nelson B Isada |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508925611 PECOS PAC ID: 0244394930 Enrollment ID: I20201204002341 |
| Provider Name | Elizabeth W Maina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013505668 PECOS PAC ID: 7315351251 Enrollment ID: I20210204000438 |
| Provider Name | John P Anastos |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780684886 PECOS PAC ID: 5597660175 Enrollment ID: I20210308001642 |
| Provider Name | Randall John Bjork |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265434112 PECOS PAC ID: 3678460912 Enrollment ID: I20210415002028 |
| Provider Name | David Johnson |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1467981464 PECOS PAC ID: 6204105158 Enrollment ID: I20210526001066 |
| Provider Name | Jordan Frances Geroski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265962633 PECOS PAC ID: 1153690037 Enrollment ID: I20210629002571 |
| Provider Name | Breanna Marie Kartes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538740121 PECOS PAC ID: 2264835438 Enrollment ID: I20210726001846 |
| Provider Name | Luis F Gomez |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1538570460 PECOS PAC ID: 8820499742 Enrollment ID: I20211029001728 |
| Provider Name | Jasmine Christine Christopher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013421049 PECOS PAC ID: 3971993239 Enrollment ID: I20211201001641 |
| Provider Name | Kristin A Sharp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154881993 PECOS PAC ID: 3779817986 Enrollment ID: I20220801002197 |
| Provider Name | Collese Nicole Mckee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730810078 PECOS PAC ID: 1759764483 Enrollment ID: I20220812002898 |
| Provider Name | Shauntel Nichole Marcin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689305948 PECOS PAC ID: 1658754619 Enrollment ID: I20220824001210 |
| Provider Name | Rebecca Anne Romine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861118069 PECOS PAC ID: 4880061357 Enrollment ID: I20221114001354 |
| Provider Name | Kelsey Anna Wagoner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144941758 PECOS PAC ID: 2769851872 Enrollment ID: I20221213000715 |
| Provider Name | Ngan Nguyen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1376994269 PECOS PAC ID: 5496099517 Enrollment ID: I20230918001937 |
| Provider Name | Breanne Nichole Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609554997 PECOS PAC ID: 9638523970 Enrollment ID: I20230920003569 |
| Provider Name | Carter James Andersen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1912583881 PECOS PAC ID: 2961802251 Enrollment ID: I20240802000635 |
| Provider Name | Donna Jeanene Hales-teat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841030988 PECOS PAC ID: 7810435815 Enrollment ID: I20240821000759 |
Byron M. Holm, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2855 Miller Dr, Suite 117, Plymouth, IN 46563 Phone: 574-936-7777 Fax: 574-941-1072 | |
Proactive Mso, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 510 W Adams St Ste Gl30, Plymouth, IN 46563 Phone: 812-645-1892 | |
Patel Family Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 105 Water St, Plymouth, IN 46563 Phone: 574-936-3178 Fax: 574-936-1084 | |
Premier Medical Imaging Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2855 Miller Dr Ste 113b, Plymouth, IN 46563 Phone: 574-941-1090 Fax: 574-941-1095 | |
Holm Medical Clinic Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2855 Miller Dr Ste 205, Plymouth, IN 46563 Phone: 574-286-0200 | |
Family Medicine Center Of Plymouth Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1904 Lake Ave, Plymouth, IN 46563 Phone: 574-936-3178 Fax: 574-936-1084 |