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Deactivated NPI 1427187798 Deactivated / Inactive NPI Male Practitioner

Dr. James Edward Wack , MD

General Practice • South Bend, IN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. James Wack has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 05, 2007
NPI Deactivation Date January 04, 2018
Total Practice Duration ~11 Years of Practice (2007 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. James Wack, MD was a registered General Practice practicing in South Bend, IN. Throughout an active medical career spanning 11 years, Dr. Wack provided care at the practice location at 714 N MICHIGAN ST until profile deactivation on 2018-01-04.

Practice Location & Contact Primary Location

Practice Address

714 N Michigan St

South Bend, IN 466011035

Telephone 5746477477
Associated Practice Facility / Clinic
🏢 Beacon Medical Group, Inc. Facility NPI 1609828946

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in South Bend, IN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 30.1 Yrs
Regional Practice Density
3 Specialists

Practicing in South Bend, IN (190 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License IN 01017207A

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. David Talarico , MD

Student in an Organized Health Care Education/Training Program

NPI 1013701754

Doctor of Medicine (M.D.)

Dr. Abigail Reese , DO

Student in an Organized Health Care Education/Training Program

NPI 1023943164

Doctor of Osteopathic Medicine (D.O.)

NPI 1033115852

Doctor of Medicine (M.D.)

Dr. Matthew Dupre , MD

Family Medicine

NPI 1043570369

Doctor of Medicine (M.D.)

Dr. Richard Ward , MD

Family Medicine

NPI 1043650781

Doctor of Medicine (M.D.)

Dr. Victoria Bawel , MD

Student in an Organized Health Care Education/Training Program

NPI 1063260107

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 04, 2018

Record deactivated on January 04, 2018

NPI Profile Active June 16, 2009

NPI status registered as active in NPPES database

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Updated Practice Location June 16, 2009

Registered at 714 N MICHIGAN ST, SOUTH BEND, IN 466011035 (Tel: 5746477477)

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Updated Business Mailing Address June 16, 2009

Registered at 3355 DOUGLAS RD, SUITE 300, SOUTH BEND, IN 466351781

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Provider Name / Credentials Updated June 16, 2009

Recorded as JAMES WACK, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 16, 2009

General Practice (License #01017207A in IN)

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Initial NPI Registration & Enumeration March 05, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1427187798
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 05, 2007
Last Update: June 16, 2009
Deactivation Date: January 04, 2018

Mailing Address

3355 Douglas Rd, Suite 300

South Bend, IN 466351781

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.