Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shane Michael Ditty, MD

Individual provider Anesthesiology Physician · NPI 1104039288

Shane Michael Ditty, MD is an Anesthesiology in South Bend, Indiana. Graduated from Indiana University School of Medicine in 2003, 23 years ago. Practices with Southeast Anesthesiologists, Inc, a 92-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
23
Trained at
Indiana University School of Medicine
Licensed in
IN
In the registry since
2007
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

416 E Monroe St Ste 200
South Bend, IN 46601-2371
Phone: (574) 232-8119
Fax: (574) 288-0235
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Anesthesiology Physician (primary) Taxonomy 207L00000X · Licence 01060795 (IN)

Record details

NPI number1104039288
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 7, 2007
Last updated in NPPESOctober 6, 2008
Mailing address416 E Monroe St, Ste. 200, South Bend, IN 46601-2371

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyANESTHESIOLOGY
Medical schoolINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduated 2003 (23 years in practice)
Group practice Southeast Anesthesiologists, Inc. — 92 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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