Active NPI
David D'Andrea, MD
- Diagnostic Radiology Physician
- Mishawaka, IN
National Provider Identifier
1366437899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 01054877
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200353120 | Medicaid | IN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 01054877 | IN | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New 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.
-
- Rehabilitation Hospital Unit
- South Bend, IN
- NPI 1780564781
-
- Magnetic Resonance Imaging (MRI) Clinic/Center
- South Bend, IN
- NPI 1447252200
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.