NPIMap

Individual provider Active NPI

Camillo M Mendoza, MD

  • Internal Medicine Physician
  • Brazil, IN
National Provider Identifier
1023081395
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01049692A Issued in IN
Practice address
1011 E National Ave
Brazil, IN 47834-2713
Phone
(812) 446-3278
Fax
(812) 446-3508
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01049692A IN Primary

Addresses

Primary practice location

1011 E National Ave
Brazil, IN 47834-2713

Mailing address

1011 E National Ave
Brazil, IN 47834-2713
Phone (812) 446-3278

Other identifiers 1

IdentifierTypeStateIssuer
200217540AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100325000015 IN Practitioner - Internal Medicine 2062557606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine Practice LLCGroup PAC ID 0547393902, 2 clinicians

Practice addresses (Care Compare)

1011 E National Ave
Brazil, IN 47834-2713
Phone (812) 446-3278

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Bloomington, IN, CCN 157578
  • Centerwell Home Health Home health agency, Terre Haute, IN, CCN 157530
  • Visiting Nurse Association of the Wabash Valley in Home health agency, Terre Haute, IN, CCN 157015
  • Southerncare Indianapolis Hospice, Bloomington, IN, CCN 151572
  • Union Hospital Inc Hospital, Terre Haute, IN, CCN 150023
  • Ascension St Vincent Clay Hospital, Brazil, IN, CCN 151309
  • Terre Haute Regional Hospital Hospital, Terre Haute, IN, CCN 150046
  • Sullivan County Community Hospital Hospital, Sullivan, IN, CCN 151327
  • Greene County General Hospital Hospital, Linton, IN, CCN 151317
  • Cobblestone Crossings Health Campus Nursing home, Terre Haute, IN, CCN 155772
  • Hutsonwood at Brazil Nursing home, Brazil, IN, CCN 155503
  • Cloverleaf of Knightsville Nursing home, Knightsville, IN, CCN 155542

Merit-based Incentive Payment System (MIPS)

Final score
92.39 of 100Reported as individual
Quality
89.17
Improvement activities
40
Cost
71.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01049692AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Practice, LLC Internal Medicine CurrentSince Jul 1, 2010 Accepting new patients
Union Hospital Inc. Current Accepting new patients
Terre Haute Heart Center, Inc Past Accepting new patients

Locations

1011 E National Ave
Brazil, IN 47834
Phone (812) 446-3278

455 E Hospital Ln
Terre Haute, IN 47802
Phone (812) 238-1521

Interoperability endpoints

  • Direct secure messaging: cmendoza@unionhealth.cernerdirect.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cobblestone Crossings Health CampusTerre Haute, IN, CCN 155772 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 15, 2025
Apr 15, 2025
Hutsonwood at BrazilBrazil, IN, CCN 155503 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2017
Jan 1, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1023081395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 E NATIONAL AVE",
            "city": "BRAZIL",
            "state": "IN",
            "postal_code": "478342713",
            "telephone_number": "812-446-3278",
            "fax_number": "812-446-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 E NATIONAL AVE",
            "city": "BRAZIL",
            "state": "IN",
            "postal_code": "478342713",
            "telephone_number": "812-446-3278",
            "fax_number": "812-446-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "CAMILLO",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01049692A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200217540A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brazil, IN

Sources for this page

Verify at the official NPI Registry.