Individual provider Active NPI

Jesus Diaz-Muniz, MD

  • General Practice Physician
  • Greendale, IN
National Provider Identifier
1144410135
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
01067757A Issued in IN
Practice address
816 Rudolph Way
Greendale, IN 47025-8312
Phone
(812) 537-1668
Fax
(812) 537-1625
NPI assigned
Jul 26, 2007
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 31630 OK
General Practice Physician 208D00000X 01067757A IN Primary

Addresses

Primary practice location

816 Rudolph Way
Greendale, IN 47025-8312

Mailing address

6312 E 101St St
Tulsa, OK 74137-7007
Phone (918) 456-2549

Other names 1

  • Dr. Jesus Diaz Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260318001133 IN Practitioner - Family Practice 7315226545 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

Practice addresses (Care Compare)

150 W Market St
Suite 400
Indianapolis, IN 46204-2810
Phone (855) 743-2247

8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01067757AINMDGeneral Practice Physician
31630OKMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Indiana Treatment Center, LLC PastSince Jun 27, 2021 Accepting new patients
East Indiana Comprehensive Treatment Center PastSince Jun 27, 2021 Accepting new patients
Seymour Treatment Center, LLC PastSince Sep 1, 2021 Accepting new patients

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1144410135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6312 E 101ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377007",
            "telephone_number": "918-456-2549",
            "fax_number": "918-893-6202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 RUDOLPH WAY",
            "city": "GREENDALE",
            "state": "IN",
            "postal_code": "470258312",
            "telephone_number": "812-537-1668",
            "fax_number": "812-537-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ-MUNIZ",
        "first_name": "JESUS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-26",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OK",
            "license": "31630",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "01067757A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESUS",
            "last_name": "DIAZ",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greendale, IN

Sources for this page

Verify at the official NPI Registry.