Family Medicine Center of SJRMC – Family Medicine Physician, NPI 1780766261
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Family Medicine Center of SJRMC
707 CEDAR ST, STE 200
SJHS PROVIDER SERVICES
SOUTH BEND, IN 466172057
Phone: (574) 335-8700
Fax: (574) 335-0741
Type: Mailing
5215 HOLY CROSS PKWY
MISHAWAKA, IN 465451469
Phone: (574) 335-8707
Fax: (574) 335-0741
Type: Mailing
611 E DOUGLAS RD, STE 407
FAMILY MEDICINE CENTER OF SJRMC
MISHAWAKA, IN 465451468
Phone: (574) 335-6500
Fax: (574) 335-0772
Type: Location
611 E Douglas Rd, Ste 101
Saint Joseph Foot and Ankle Center
Mishawaka, IN 465451464
Phone: (574) 335-6800
Fax: (574) 335-0732
Type: Location
611 E Douglas Rd, Ste 137
Sports Medicine Institute
Mishawaka, IN 465451464
Phone: (574) 335-6214
Fax: (574) 335-6215
Type: Location
102, Lake Avenue, White Island Shores, Wareham, Plymouth County, Massachusetts, 02538, United States
PLYMOUTH, IN 465637830
Phone: (574) 335-6800
Fax: (574) 335-0732
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-08-31 (77 days away).
Enrollment records
1
Earliest due date
2026-08-31
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 |
|---|---|---|---|---|
| O20031223000724 | O | Clinic/Group Practice | IN | 2026-08-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46617)
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