Individual provider Active NPI

David D'Andrea, MD

  • Diagnostic Radiology Physician
  • Mishawaka, IN
National Provider Identifier
1366437899
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01054877 Issued in IN
Practice address
620 W Edison Rd
Suite 110
Mishawaka, IN 46545-2784
Phone
(574) 258-1100
Fax
(574) 258-1101
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01054877 IN Primary
Body Imaging Physician 2085B0100X 01054877 IN
Neuroradiology Physician 2085N0700X 01054877 IN
Nuclear Radiology Physician 2085N0904X 01054877 IN
Pediatric Radiology Physician 2085P0229X 01054877 IN
Therapeutic Radiology Physician 2085R0203X 01054877 IN
Vascular & Interventional Radiology Physician 2085R0204X 01054877 IN
Diagnostic Ultrasound Physician 2085U0001X 01054877 IN

Addresses

Primary practice location

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

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
200353120MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01054877INMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Indiana Magnetic Resonance Center, LLP Past Accepting new patients
Memorial Hospital of South Bend Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1366437899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD",
            "address_2": "SUITE 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": "SUITE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100",
            "fax_number": "574-258-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'ANDREA",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01054877",
            "primary": true
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "IN",
            "license": "01054877",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "IN",
            "license": "01054877",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "IN",
            "license": "01054877",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "IN",
            "license": "01054877",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "IN",
            "license": "01054877",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IN",
            "license": "01054877",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "IN",
            "license": "01054877",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200353120",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.