Provider Demographics
NPI:1609846062
Name:RANSOM, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RANSOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:574-335-8707
Mailing Address - Fax:
Practice Address - Street 1:12563 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9226
Practice Address - Country:US
Practice Address - Phone:574-335-8300
Practice Address - Fax:574-335-0775
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059860A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200500100Medicaid
IN1102295241OtherANTHEM BCBS
INP01673083OtherRR MEDIARE
IN000000904442OtherBCBS IRELAND MEDPOINT
INP00246920OtherRR MEDICARE
IN200500100Medicaid
IN000000904442OtherBCBS IRELAND MEDPOINT
IN000000904453OtherBCBS
IN000000377277OtherANTHEM
IN5710110004Medicare NSC