BRIAN K. PENROSE (NPI# 1437508116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437508116 |
| Entity Type | Individual |
| Full Name | BRIAN K. PENROSE |
| Credential | DPM |
| Practice Address |
611 E Douglas Rd Ste 101 Mishawaka IN 46545-1464 |
| Mailing Address |
707 E Cedar St Ste 200 South Bend IN 46617-2057 |
| Practice Telephone | 5743356800 |
| Practice Fax Number | 5743350732 |
| Mailing Telephone | 5743358700 |
| Mailing Fax Number | 5743350741 |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2020-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
07001313A | IN | Podiatric Medicine & Surgery Service Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | MEDICARE | IN1933075 | 01 |
| IN | IN MEDICAL LICENSE | 41000341A | 01 |
| IN | ANTHEM | 000001293859 | 01 |
| IN | MEDICARE | 738460022 | 01 |
| IN | ANTHEM | 000001366840 | 01 |
| IN | 201375910 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 611 E Douglas Rd, Suite 406, Mishawaka, IN 465451464 | 5743356500 | 5743350771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316145360 | Brian Penrose | Marriage & Family Therapist | 19000 Homestead Rd, Bldg 1, 1st Floor, Cupertino, CA 95014-0712 | 2007-07-10 |
| Street Address |
611 E DOUGLAS RD STE 101 |
| City | MISHAWAKA |
| State | IN |
| Zip Code | 46545-1464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043847221 | Zoe Marie Simaz | Student in an Organized Health Care Education/Training Program | 611 E Douglas Rd Ste 101, Mishawaka, IN 46545-1464 | 2020-03-26 |
| 1689200552 | Christopher John Eberle | Student in an Organized Health Care Education/Training Program | 611 E Douglas Rd Ste 101, Mishawaka, IN 46545-1464 | 2020-03-22 |
| 1144781113 | Austin William Vonasek | Student in an Organized Health Care Education/Training Program | 611 E Douglas Rd Ste 101, Mishawaka, IN 46545-1464 | 2019-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649824103 | Senior Helpers | In Home Supportive Care | 230 Catalpa Drive Suite B, Mishawaka, IN 46545 | 2019-08-01 |
| 1093272114 | Candice Marie Greathouse | Physical Therapy Assistant | 3630 Hickory Road, Mishawaka, IN 46545 | 2019-02-25 |
| 1639662596 | Mishawaka Rcf Lp | Assisted Living Facility | 3630 Hickory Rd, Mishawaka, IN 46545 | 2018-06-14 |
| 1760907299 | Timothy John Howard | Emergency Medicine | 610 1/2 N Main Street, Apartment 1, Mishawaka, IN 46545 | 2017-08-05 |
| 1699203612 | Paridhie Vasudevan | Dentist | 6502 Grape Rd Ste 882, Mishawaka, IN 46545 | 2017-06-03 |
| 1780134650 | Ossip Optometry, PC | Optometrist | 5111 N. Main Street, Suite 200, Mishawaka, IN 46545 | 2016-10-04 |
| 1457730038 | Melissa Anne Douthit | Nurse Practitioner | 3665 Park Pl W Ste 300, Mishawaka, IN 46545 | 2015-05-28 |
| 1558759654 | Spine and Joint Associates of Plymouth, Inc | Chiropractor | 229 Red Coach, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1609264795 | Spine and Joint Associates of Mishawaka, Inc | Chiropractor | 229 Red Coach Trail, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1508260795 | Maribel Smith | Counselor | 2989 Heritage Ct, Mishawaka, IN 46545 | 2014-10-16 |
| Find all providers in zip 46545 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528065059 | Michael Salcedo | Podiatrist | 3665 Park Pl W, Suite 200, Mishawaka, IN 46545-3566 | 2005-06-30 |
| 1689088783 | Eric Rindlisbacher | Podiatrist | 611 E. Douglas Rd, Ste 407, Mishawaka, IN 46545-1468 | 2014-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356853873 | Hoosier Foot & Ankle LLC | Podiatrist | 7412 Rockville Rd Ste A, Indianapolis, IN 46214-3098 | 2017-10-25 |
| 1952830499 | Britney Ann Wenig | Podiatrist | 10122 E 10th St Ste 250, Indianapolis, IN 46229-2663 | 2017-06-08 |
| 1952846776 | Veronica Alexis Kacmar-fedorchak | Podiatrist | 3215 Willowcreek Rd, Portage, IN 46368-5013 | 2017-01-03 |
| 1629529029 | Associated Surgeons and Physicians, LLC | Podiatrist | 7920 W. Jefferson Blvd., Ste. 230, Fort Wayne, IN 46804-4166 | 2016-10-20 |
| 1902359714 | Aamir Mahmood | Podiatrist | 10176 W 400 N Ste D, Michigan City, IN 46360-9009 | 2016-07-28 |
| 1558756023 | Sarah Standish | Podiatrist | 1001 Hadley Rd Ste 105, Mooresville, IN 46158-1884 | 2015-04-01 |
| 1467872796 | William Joseph Edward Adams | Podiatrist | 1 Memorial Sq Ste 2100, Greenfield, IN 46140-1380 | 2014-04-25 |
| 1720406564 | Rachel Chhiba | Podiatrist | 9240 N Meridian St Ste 260, Indianapolis, IN 46260 | 2014-03-30 |
| 1245679802 | Ansgar Steven Olsen | Podiatrist | 360 Plaza Dr Ste B, Columbus, IN 47201-2960 | 2013-06-17 |
| 1033557830 | Hardeep S Minhas | Podiatrist | 2308 Roosevelt Rd, Valparaiso, IN 46383-2773 | 2013-06-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.