SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

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: SAINT JOSEPH PHYSICIAN NETWORK
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CFO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: ROBERT
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: SINK
• Authorized Official - Phone: 574-335-4654
• Mailing Address - Street 1: 707 CEDAR ST STE 200
• Mailing Address - Street 2: SJHS PROVIDER SERVICES
• Mailing Address - City: SOUTH BEND
• Mailing Address - State: IN
• Mailing Address - Zip Code: 46617-2057
• Mailing Address - Country: US
• Mailing Address - Phone: 574-335-8700
• Mailing Address - Fax: 574-335-0741
• Practice Address - Street 1: 2349 LAKE AVE STE 99
• 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: 2023-03-01

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	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	021236800	Other	FEDERAL BLACK LUNG
IN	300000756	Medicaid
IN	300041953	Medicaid
IN	300046029	Medicaid
IN	300048902	Medicaid
IN	CJ6650	Other	RR MEDICARE
IN	200162760B	Medicaid
IN	200162760G	Medicaid
IN	300026356	Medicaid
IN	300028778	Medicaid
IN	000000358580	Other	BCBS
IN	200162760C	Medicaid
IN	300038977	Medicaid
IN	300046084	Medicaid
IN	300035855	Medicaid
IN	300047494	Medicaid
IN	200162760A	Medicaid
IN	300020807	Medicaid
IN	300055981	Medicaid
IN	300000759	Medicaid
IN	300045987	Medicaid
IN	200091160B	Medicaid
IN	200162760H	Medicaid
IN	300041121	Medicaid
IN	300045460	Medicaid