SOUTH BEND MEDICAL FOUNDATION, INC – Anatomic Pathology & Clinical Pathology Physician, NPI 1649241084
Anatomic Pathology & Clinical Pathology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTH BEND MEDICAL FOUNDATION, INC
5700 SOUTHWYCK BLVD
TOLEDO, OH 436141509
Phone: (800) 288-8325
Fax: (419) 866-5453
Type: Mailing
3355 DOUGLAS RD
SOUTH BEND, IN 466351779
Phone: (574) 234-4176
Type: Location
530, North Lafayette Boulevard, South Bend, Saint Joseph County, Indiana, 46601, United States
SOUTH BEND, IN 466011004
Phone: (574) 204-5206
Fax: (574) 245-0339
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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: 2007-09-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation scheduled
Earliest CMS due date is 2026-10-31 (144 days away).
Enrollment records
1
Earliest due date
2026-10-31
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 |
|---|---|---|---|---|
| O20070928000255 | O | Independent Clinical Laboratory | IN | 2026-10-31 |
What to do next
- Monitor the published due date as it approaches.
- Plan to revalidate in PECOS within the window CMS allows before the due date.
- Verify the date on the CMS Revalidation Lookup Tool before submitting.
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 |
|---|---|---|---|---|
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 5,487 | 3,119 | $0 |
| 88341 | Special stained specimen slides to examine tissue, each additional procedure | 563 | 179 | $0 |
| 88342 | Special stained specimen slides to examine tissue, initial procedure | 418 | 352 | $0 |
| 88304 | Pathology examination of tissue using a microscope, moderately low complexity | 300 | 276 | $0 |
| 88360 | Microscopic genetic analysis of tumor, manual | 148 | 65 | $0 |
Insurance plans in this area (ZIP 43614)
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