HUBERT FORNALIK (MD) – Gynecologic Oncology Physician, NPI 1255549812
Gynecologic Oncology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
28 GYNECOLOGICAL ONCOLOGY in IN
Provider Addresses for HUBERT FORNALIK (MD)
100 E WAYNE ST STE 510
SOUTH BEND, IN 466012394
Phone: (574) 334-5400
Type: Mailing
PO BOX 781076
DETROIT, MI 482781076
Phone: (317) 528-4800
Fax: (317) 865-1479
Type: Mailing
8111 S EMERSON AVE STE 204
INDIANAPOLIS, IN 462378601
Phone: (317) 528-2555
Fax: (317) 528-2566
Type: Location
Michiana Hematology and Oncology, 5340, Holy Cross Parkway, Mishawaka, Saint Joseph County, Indiana, 46545, United States
MISHAWAKA, IN 465451470
Phone: (574) 237-1328
Type: Location
5340 Holy Cross Pkwy
Mishawaka, IN 465451470
Phone: (574) 237-1328
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 24 Open Payments records for all available years, with a total value of $520.
Total Amount is formed as General ($520) + Research ($0) + Ownership ($0) = $520.
Last reported payment date: 2024-12-13 • Largest payer in this snapshot: Merck Sharp & Dohme LLC ($91).
Total Amount
$520
General + Research + Ownership
Payments
24
Total payment records
General Amount
$520
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-13
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-07-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100730000661 | I | Gynecological Oncology | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 |
|---|---|---|---|---|
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 35 | 35 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 27 | 19 | $0 |
| 58571 | Removal of uterus, tubes, and/or ovaries through abdomen using an endoscope, 250.0 g or less | 20 | 20 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 17 | 13 | $0 |
| 38900 | Imaging of lymph nodes during surgery | 12 | 12 | $0 |
Insurance plans in this area (ZIP 46601)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IN | |
| H E M A T O L O G Y/ O N C O L O G Y | IN | |
| Gynecological Oncology, Obstetrics/Gynecology | IN | |
| Hematology/Oncology, Internal Medicine | IN | |
| Nurse Practitioner | IN | |
| Hematology/Oncology, Internal Medicine | IN | |
| H E M A T O L O G Y/ O N C O L O G Y | IN | |
| Nurse Practitioner | IN | |
| Hematology/Oncology, Internal Medicine | IN | |
| Nurse Practitioner | IN |
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