Individual provider Active NPI

Nathan D'Emilio, DO

  • Student in an Organized Health Care Education/Training Program
  • Mishawaka, IN
National Provider Identifier
1407640642
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468
Phone
(574) 335-6500
NPI assigned
Apr 4, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468

Mailing address

611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20250609002090 IN Order and Referring Only - Family PracticePractitioner - Family Practice 3870003825

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1743724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1407640642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 407",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 407",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451468",
            "telephone_number": "574-335-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'EMILIO",
        "first_name": "NATHAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-04",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.