Charmaine Haikaeli Mziray-Andrew, M.D.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

036-116417 Issued in IL

Practice address

301 N 8TH St
Suite Pav 4a
Springfield, IL 62701-1041

Phone

(217) 545-8000

Fax

(217) 545-5018

NPI assigned

Apr 17, 2007

Last updated

Dec 8, 2020By the provider in NPPES

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charmainemzirayandrew@siusm.allscriptsdirect.net

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.

• Siu Physicians & Surgeons, Inc

  dba SIU HealthCare

  • Endocrinology, Diabetes & Metabolism Physician
  • Springfield, IL
  • NPI 1558385989
  Medicare reassignment NPD
• Board of Trustees of Southern Illinois University

  dba Carbondale Care A Van

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1215978127
  NPD
• Siu Physicians & Surgeons, Inc

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1164055976
  NPD

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1225254659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19658",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949658",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N 8TH ST",
            "address_2": "SUITE PAV 4A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627011041",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MZIRAY-ANDREW",
        "first_name": "CHARMAINE",
        "middle_name": "HAIKAELI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-116417",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IL",
            "license": "036-116417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036116417",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charmainemzirayandrew@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "301 N 8th St",
            "address_2": "SUITE PAV 4A",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627011041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thandeka Myeni, M.D.
• James Edward Myers, PSY.D.
• Phillip W Myers, M.D.
• Talia A Myers, PLPC
• Elizabeth Myint, M.D.
• Kathleen Ann Nacke, NNP
• Robert Nadler, MD
• Kristina Lynn Nagel, RPH
• Sanjai Nagendra, MD
• Goutami Kanna Nallamothu, M.D.

• Pediatric Gastroenterology Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Pediatric Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.