Individual provider Active NPI

Amish Dushyant Pandya, DMD

  • Dentist
  • Munster, IN
National Provider Identifier
1508856980
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12011539A Issued in IN
Practice address
9335 Calumet Ave
Suite a
Munster, IN 46321-4175
Phone
(219) 836-2092
Fax
(219) 836-9501
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12011539A IN Primary

Addresses

Primary practice location

9335 Calumet Ave
Suite a
Munster, IN 46321-4175

Mailing address

9335 Calumet Ave
Suite a
Munster, IN 46321-4175
Phone (219) 836-2092

Other identifiers 1

IdentifierTypeStateIssuer
201048300MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210106003036 OH Order and Referring Only - DentistPractitioner - Dentist 1153734314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12011539AINMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Eastman Dental Past Accepting new patients
Nothing But the Tooth LLC PastSince Nov 10, 2019 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": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1508856980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9335 CALUMET AVE",
            "address_2": "SUITE A",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214175",
            "telephone_number": "219-836-2092",
            "fax_number": "219-836-9501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9335 CALUMET AVE",
            "address_2": "SUITE A",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214175",
            "telephone_number": "219-836-2092",
            "fax_number": "219-836-9501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANDYA",
        "first_name": "AMISH",
        "middle_name": "DUSHYANT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011539A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201048300",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.