Individual provider Active NPI

Michael Wayne Dye Jr., M.D.

  • Diagnostic Radiology Physician
  • Mishawaka, IN
National Provider Identifier
1205057635
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01069365 Issued in IN
Practice address
620 W Edison Rd
Ste 110
Mishawaka, IN 46545-2784
Phone
(574) 258-1100
Fax
(574) 258-1101
NPI assigned
May 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 01069365A IN
Diagnostic Radiology Physician 2085R0202X 01069365 IN Primary

Addresses

Primary practice location

620 W Edison Rd
Ste 110
Mishawaka, IN 46545-2784

Mailing address

620 W Edison Rd
Ste 110
Mishawaka, IN 46545-2784
Phone (574) 258-1100

Other identifiers 1

IdentifierTypeStateIssuer
201020750MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20110712000728 IN Practitioner - Diagnostic RadiologyPractitioner - Other (Physician) 3274701511 Reassigns benefits to 2 organizations
I20220512001882 OH Practitioner - Diagnostic Radiology 3274701511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Alabama School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
P.E.T. Imaging Services, LLCGroup PAC ID 2668412842, 8 clinicians
Fort Wayne Radiology Associates LLCGroup PAC ID 5294624060, 35 clinicians

Practice addresses (Care Compare)

3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone (260) 469-4738

442 W High St
Bryan, OH 43506-1681
Phone (419) 636-4517

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.28 of 100Reported as group
Quality
77.29
Improvement activities
40
Cost
73.88

Merit-based Incentive Payment System (MIPS)

Final score
85.81 of 100Reported as group
Quality
80.59
Promoting interoperability
100
Improvement activities
40
Cost
72.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01069365AINMDNeuroradiology Physician
01069365INMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospitals and Wellness Centers CurrentSince Jun 17, 2022 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Jun 17, 2022 Accepting new patients
Fort Wayne Radiology Associates LLC Diagnostic Radiology CurrentSince Apr 15, 2022 Accepting new patients
P.E.T. Imaging Services, LLC Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Breast Diagnostic Center, LLC Diagnostic Radiology Past Accepting new patients

Locations

3707 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-4000

121 Westfield Dr
Archbold, OH 43502
Phone (419) 445-2015

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

442 W High St
Bryan, OH 43506
Phone (260) 266-8210

909 E Snyder Ave
Montpelier, OH 43543
Phone (419) 485-3154

1035 W Wayne St
Paulding, OH 45879
Phone (419) 399-4080

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373414400000",
    "number": "1205057635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD",
            "address_2": "STE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100",
            "fax_number": "574-258-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD",
            "address_2": "STE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100",
            "fax_number": "574-258-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYE",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2013-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "IN",
            "license": "01069365A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01069365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201020750",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.