Scott Edward Mimms, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

01068514A Issued in IN

Practice address

1704 Lafayette Rd Ste 5
Crawfordsville, IN 47933

Phone

(765) 361-3011

Fax

(765) 362-5540

NPI assigned

May 23, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: smimms429383@direct.franciscanalliance.org

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.

• Community Hospitals of Indiana

  dba Community Bariatric Surgeons

  • Obesity Medicine (Internal Medicine) Physician
  • Indianapolis, IN
  • NPI 1811121189
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• University Surgeons, Inc.

  • Surgery Physician
  • Indianapolis, IN
  • NPI 1316966229
  NPD (past)

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1104084326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 LAFAYETTE RD STE 5",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "47933",
            "telephone_number": "765-361-3011",
            "fax_number": "765-362-5540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7250 Clearvista Drive",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462564640",
            "country_code": "US",
            "telephone_number": "317-621-5673",
            "fax_number": "317-621-6040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7250 Clearvista Drive",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462564640",
            "country_code": "US",
            "telephone_number": "317-621-5673",
            "fax_number": "317-621-6040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIMMS",
        "first_name": "SCOTT",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-23",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01068514A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000781470",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200986830",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smimms429383@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1704 Lafayette Rd Ste 5",
            "city": "Crawfordsville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "47933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John Meskimen, ATC, LAT
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• Louis S Metzman, MD
• MH Nursing of Indiana, PC
• Rae Anne Miller, APRN BC
• Mishler Dental LLC
• Dane Gregory Mishler, DDS.
• Kirtlyn Mitchell, RBT
• Jennifer Mittal, M.ED.
• Kailea Modglin, RBT

• Surgery Physician in Crawfordsville, IN
• Providers in Crawfordsville, IN by specialty
• Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.