MEDICARE: SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	207RI0011X	Interventional Cardiology Physician
3	207RI0200X	Infectious Disease Physician
4	207VM0101X	Maternal & Fetal Medicine Physician
5	2086S0129X	Vascular Surgery Physician
6	363L00000X	Nurse Practitioner
7	208800000X	Urology Physician
8	2084P0800X	Psychiatry Physician
9	207V00000X	Obstetrics & Gynecology Physician
10	207RC0001X	Clinical Cardiac Electrophysiology Physician
11	207RC0000X	Cardiovascular Disease Physician
12	2084N0400X	Neurology Physician
13	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
14	207Y00000X	Otolaryngology Physician
15	207RP1001X	Pulmonary Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
17	CJ6650	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24	021236800	OTHER	IN	FEDERAL BLACK LUNG
25	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
26	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225082878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PKWY
Second Line	:	PROVIDER SERVICES-ENROLLMENT
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2349 LAKE AVE STE 99
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7837
Country	:	US
Telephone Number	:	574-948-5340
Fax Number	:	574-948-5494

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER JAMES KARAM
Credential	:
Telephone Number	:	574-335-5000

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/03/2026

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