MEDICARE: SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	363LF0000X	Family Nurse Practitioner
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
4	207QS0010X	Sports Medicine (Family Medicine) Physician
5	207R00000X	Internal Medicine Physician
6	213E00000X	Podiatrist
7	213ES0103X	Foot & Ankle Surgery Podiatrist
8	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000875287	OTHER	IN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538585187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PARKWAY
Second Line	:	SAINT JOSEPH PROVIDER SERVICES
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0741

Provider Business Practice Location Address
First Line	:	1919 LAKE AVE STE 102B
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7830
Country	:	US
Telephone Number	:	574-335-6800
Fax Number	:	574-948-5480

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

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	03/06/2026

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Directions to “SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC ” Practice Location

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