Mamata Eagam, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS14468 Issued in FL

Practice address

902 Provident Drive
Suite a
Warsaw, IN 46580-3379

Phone

(574) 269-8338

Fax

(574) 269-8339

NPI assigned

Apr 22, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, WI, TX3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: meagam86158@tuftsmedicine.direct-ci.com

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.

• Ascension Medical Group-Southeast Wisconsin Inc

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Pediatrics

  Medicare reassignment NPD
• Florida Hospital Medical Group Inc

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Pediatrics

  Medicare reassignment NPD
• Children'S Physician Services of South Texas

  • Plastic Surgery Physician
  • Corpus Christi, TX
  • NPI 1568658227
  Medicare reassignment
• Florida Hospital Medical Group Inc

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1174797179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY",
            "address_2": "SUITE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3513",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 PROVIDENT DRIVE",
            "address_2": "SUITE A",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803379",
            "telephone_number": "574-269-8338",
            "fax_number": "574-269-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAGAM",
        "first_name": "MAMATA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-22",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "02004718A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS14468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Dumond
• Darby Duquenne
• Donald A Durecki, MD
• Jenelle Dushane, PHARM D
• Dennis-James Dutcher, MA
• East Center Dental
• East Warsaw Dental Group LLC
• Rachel Easterling
• Lucy Eberly, LCSW
• Brooke Alise Ebersole, OPT

• Pediatrics Physician in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.