Active NPI
Amin Bandealy, M.D.
- Internal Medicine Physician
- Memphis, TN
National Provider Identifier
1174555247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 14032
- Practice address
- 350 N Humphreys Blvd
Memphis, TN 38120-2177 - Phone
- (901) 227-0497
- Fax
- (901) 227-0499
- NPI assigned
- Jul 7, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 14032 | MS | Primary |
Addresses
Primary practice location
350 N Humphreys Blvd
Memphis, TN 38120-2177
Mailing address
8990 Germantown Rd Extended
Olive Branch, MS 38654
Phone (662) 893-1160
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 |
|---|---|---|---|
| 14032 | MS | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians of Memphis LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174555247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8990 GERMANTOWN RD EXTENDED",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "38654",
"telephone_number": "662-893-1160",
"fax_number": "662-893-1166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 N HUMPHREYS BLVD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381202177",
"telephone_number": "901-227-0497",
"fax_number": "901-227-0499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDEALY",
"first_name": "AMIN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "14032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.