Individual provider Active NPI

Andrew J Fiedler, MD

  • Cardiovascular Disease Physician
  • South Bend, IN
National Provider Identifier
1487651758
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
01043726A Issued in IN
Practice address
615 N Michigan St
South Bend, IN 46601-1033
Phone
(574) 647-1000
NPI assigned
Jul 1, 2005
Last updated
Dec 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 01043726A IN Primary

Addresses

Primary practice location

615 N Michigan St
South Bend, IN 46601-1033

Mailing address

62480 Turkey TRL
South Bend, IN 46614-9416
Phone (574) 850-5671

Other identifiers 1

IdentifierTypeStateIssuer
200046990MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address FIEDLER@mybeacon.cernerdirect.com

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
I20040817000072 IN Practitioner - Cardiovascular Disease (Cardiology) 0941273163 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital of South Bend CurrentSince Sep 1, 1971 Accepting new patients
Memorial Hospital of South Bend CurrentSince Sep 1, 1971 Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

Interoperability endpoints

  • Direct secure messaging: fiedler@mybeacon.cernerdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1487651758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62480 TURKEY TRL",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466149416",
            "telephone_number": "574-850-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIEDLER",
        "first_name": "ANDREW",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01043726A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200046990",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "FIEDLER@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "615 N Michigan St",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.