Lydia K Mertz, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01031929A Issued in IN

Practice address

608 Oakland Ave
Elkhart, IN 46516-3819

Phone

(574) 523-2127

Fax

(574) 522-2192

NPI assigned

Sep 4, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1184872046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 PROFESSIONAL DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465263819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 OAKLAND AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465163819",
            "telephone_number": "574-523-2127",
            "fax_number": "574-522-2192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 Professional Dr",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465263819",
            "country_code": "US",
            "telephone_number": "574-537-8326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERTZ",
        "first_name": "LYDIA",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01031929A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100414680",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.