SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC – Hospitalist Physician, NPI 1821402876
Hospitalist Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC
707 CEDAR ST STE 200
SAINT JOSEPH PHYSICIAN NETWORK-CBO
SOUTH BEND, IN 466172057
Phone: (574) 335-8700
Fax: (574) 335-0760
Type: Mailing
5215 HOLY CROSS PARKWAY
SAINT JOSEPH PROVIDER SERVICES
MISHAWAKA, IN 465451469
Phone: (574) 335-8707
Fax: (574) 335-0741
Type: Mailing
1915 LAKE AVE
PLYMOUTH, IN 465639366
Phone: (574) 948-4000
Fax: (574) 948-5454
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)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (253 days ago).
Enrollment records
1
Earliest due date
2025-09-30
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 |
|---|---|---|---|---|
| O20031223000588 | O | Clinic/Group Practice | IN | 2025-09-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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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