NPIMap

Individual provider Active NPI

Michael Lee Gallentine, MD

  • Urology Physician
  • Evansville, IN
National Provider Identifier
1356311583
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
20757 Issued in NE
Practice address
920 S Hebron Ave
Evansville, IN 47714-4086
Phone
(812) 473-1111
NPI assigned
Jan 23, 2006
Last updated
Jun 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 20757 NE Primary

Addresses

Primary practice location

920 S Hebron Ave
Evansville, IN 47714-4086

Mailing address

920 S Hebron Ave
Evansville, IN 47714-4086

Other practice location 1

611 W Francis St
Suite 200
North Platte, NE 69101-0614
Phone (308) 568-3500

Other identifiers 1

IdentifierTypeStateIssuer
100255040-00MedicaidNE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address michael.gallentine.1@7598.direct.athenahealth.com St Mary's Medical Group, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161128000114 IN Practitioner - Urology 9638278880 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Northwestern University Feinberg Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical Group LLCGroup PAC ID 1153493341, 230 clinicians

Practice addresses (Care Compare)

920 S Hebron Ave
Evansville, IN 47714-4086
Phone (812) 473-1111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection19

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Daviess County Hospital Current Accepting new patients
Daviess County Hospital Current Accepting new patients
St Mary's Medical Group, LLC CurrentSince Dec 1, 2016 Accepting new patients
Daviess County Hospital CurrentSince Jul 1, 2025 Accepting new patients
Daviess County Hospital CurrentSince Jul 1, 2025 Accepting new patients
Primary Physicians Network LLC Current Accepting new patients
Daviess County Hospital CurrentSince Jul 1, 2025 Accepting new patients
St Mary's Medical Group, LLC CurrentSince Dec 1, 2016 Accepting new patients
North Platte Nebraska Hospital Corporation PastSince Jun 30, 2011 Accepting new patients
Urological Associates, Inc. Urology Past Accepting new patients

Locations

100 S Rosenberger Ave
Ste B300
Evansville, IN 47712
Phone (812) 485-7111

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

920 S Hebron Ave
Evansville, IN 47714
Phone 8124731111253

1314 E Walnut St
Washington, IN 47501
Phone (812) 254-2250

1402 Grand Ave
Washington, IN 47501
Phone (812) 254-2250

Organizations & group practices 10

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.

Hospital & facility affiliations 10

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": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1356311583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 S HEBRON AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477144086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 S HEBRON AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477144086",
            "telephone_number": "812-473-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 W Francis St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "North Platte",
            "state": "NE",
            "postal_code": "691010614",
            "country_code": "US",
            "telephone_number": "308-568-3500",
            "fax_number": "308-568-3510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLENTINE",
        "first_name": "MICHAEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NE",
            "license": "20757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100255040-00",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.gallentine.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St Mary's Medical Group, LLC",
            "address_1": "920 S Hebron Ave",
            "city": "Evansville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "477144086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.