Provider Demographics
| NPI: | 1225082878 |
|---|---|
| Name: | SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. |
| Entity type: | Organization |
| Organization Name: | SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHRISTOPHER |
| Authorized Official - Middle Name: | JAMES |
| Authorized Official - Last Name: | KARAM |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 574-335-5000 |
| Mailing Address - Street 1: | 5215 HOLY CROSS PKWY |
| Mailing Address - Street 2: | PROVIDER SERVICES-ENROLLMENT |
| Mailing Address - City: | MISHAWAKA |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 46545-1469 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2349 LAKE AVE STE 99 |
| Practice Address - Street 2: | |
| Practice Address - City: | PLYMOUTH |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 46563-7837 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 574-948-5340 |
| Practice Address - Fax: | 574-948-5494 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | TRINITY HEALTH CORPORATION |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-19 |
| Last Update Date: | 2025-01-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IN | 300035855 | Medicaid | |
| IN | 300041121 | Medicaid | |
| IN | 300047494 | Medicaid | |
| IN | 300055981 | Medicaid | |
| IN | CJ6650 | Other | RR MEDICARE |
| IN | 021236800 | Other | FEDERAL BLACK LUNG |
| IN | 200091160B | Medicaid | |
| IN | 200162760B | Medicaid | |
| IN | 300041953 | Medicaid | |
| IN | 300045987 | Medicaid | |
| IN | 300028778 | Medicaid | |
| IN | 300046029 | Medicaid | |
| IN | 300046084 | Medicaid | |
| IN | 200162760H | Medicaid | |
| IN | 300020807 | Medicaid | |
| IN | 300026356 | Medicaid | |
| IN | 200162760A | Medicaid | |
| IN | 200162760G | Medicaid | |
| IN | 300000759 | Medicaid | |
| IN | 300048902 | Medicaid | |
| IN | 200162760C | Medicaid | |
| IN | 300000756 | Medicaid | |
| IN | 300038977 | Medicaid | |
| IN | 300045460 | Medicaid | |
| IN | 300055981 | Medicaid |
