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is a Physician Assistant based in Elkhart, Indiana. is licensed to practice in Indiana (license number ) and their current practice location is 640 Industrial Pkwy, Elkhart, Indiana. It can be reached at their office (for appointments etc.) via phone at (574) 522-7203.

NPI number for is 1316955644 and their current mailing address is 640 Industrial Pkwy, Elkhart, Indiana. does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1316955644.

Contact Information

640 Industrial Pkwy,
Elkhart, IN 46516-5414
(574) 522-7203
(574) 522-7405

Map and Direction




Healthcare Provider's Profile

Full Name
TypeFacility
SpecialityPhysician Assistant
Location640 Industrial Pkwy, Elkhart, Indiana
Accepts Medicare AssignmentsDoes not participate in Medicare Program. The facility may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1316955644
  • Provider Enumeration Date: 08/03/2006
  • Last Update Date: 08/22/2020

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1316955644NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
111N00000XChiropractor (* (Not Available))Primary
207Q00000XFamily Medicine (* (Not Available))Primary
225100000XPhysical Therapist (Indiana)Primary
363A00000XPhysician Assistant (Indiana)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address

640 Industrial Pkwy,
Elkhart, IN 46516-5414

Ph: (574) 522-7203
640 Industrial Pkwy,
Elkhart, IN 46516-5414

Ph: (574) 522-7203

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.