Active NPI
Richard T Miyamoto, M.D.
- Otology & Neurotology Physician
- Indianapolis, IN
National Provider Identifier
1144258625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otology & Neurotology Physician
- License
- 01024300
- Practice address
- 705 Riley Hospital Dr
Suite 0860
Indianapolis, IN 46202-5109 - Phone
- (317) 274-3556
- Fax
- (317) 278-3743
- NPI assigned
- Jun 30, 2006
- Last updated
- Feb 18, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otology & Neurotology Physician | 207YX0901X | 01024300 | IN | Primary |
Addresses
Primary practice location
705 Riley Hospital Dr
Suite 0860
Indianapolis, IN 46202-5109
Mailing address
250 N Shadeland Ave
Ste 130 Provider Enrollment
Indianapolis, IN 46219-4959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100061170 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01024300 | IN | MD | Otology & Neurotology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients | |
| University Otolaryngology Associates, Inc. | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Otolaryngology Physician
- Indianapolis, IN
- NPI 1992715452
-
- Otolaryngology Physician
- Indianapolis, IN
- NPI 1275563447
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392681600000",
"number": "1144258625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"address_2": "STE 130 PROVIDER ENROLLMENT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 RILEY HOSPITAL DR",
"address_2": "SUITE 0860",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025109",
"telephone_number": "317-274-3556",
"fax_number": "317-278-3743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIYAMOTO",
"first_name": "RICHARD",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2014-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0901X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otology & Neurotology",
"state": "IN",
"license": "01024300",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100061170",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.