Unknown Individual – Family Medicine Physician, NPI 1104821313
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
915 N Van Buren St
Shipshewana, IN 465658702
Phone: (260) 768-4185
Type: Location
524, East McKinley Avenue, Mishawaka, Saint Joseph County, Indiana, 46545, United States
MISHAWAKA, IN 465456285
Phone: (574) 256-2556
Fax: (574) 258-4278
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $51.
Total Amount is formed as General ($51) + Research ($0) + Ownership ($0) = $51.
Last reported payment date: 2023-02-17 • Largest payer in this snapshot: ABBVIE INC. ($24).
Total Amount
$51
General + Research + Ownership
Payments
3
Total payment records
General Amount
$51
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-02-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $24 |
| Kowa Pharmaceuticals America, Inc. | $13 |
| Amgen Inc. | $13 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 38 | 33 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 14 | 14 | $0 |
Insurance plans in this area (ZIP 46565)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | IN | 20610 | Aspiration and/or injection of large joint or joint capsule | 56 | 41 |
| FAMILY MEDICINE | IN | 73630 | X-ray of foot, minimum of 3 views | 18 | 15 |
| FAMILY MEDICINE | IN | 83036 | Hemoglobin A1C level | 86 | 63 |
| FAMILY MEDICINE | IN | 85610 | Blood test, clotting time | 96 | 14 |
| FAMILY MEDICINE | IN | 90670 | Pneumococcal vaccine for injection into muscle | 15 | 15 |
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