Active NPI
George R Drew, DO
- Emergency Medicine Physician
- Mishawaka, IN
National Provider Identifier
1639223605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 02003439
- Practice address
- 5215 Holy Cross Pkwy
Emergency Department
Mishawaka, IN 46545-1469 - Phone
- (574) 335-5000
- Fax
- (574) 273-1137
- NPI assigned
- Jan 23, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 5101009164 | MI | |
| Emergency Medicine Physician | 207P00000X | 02003439 | IN | Primary |
Addresses
Primary practice location
5215 Holy Cross Pkwy
Emergency Department
Mishawaka, IN 46545-1469
Mailing address
5215 Holy Cross Pkwy
Emergency Department
Mishawaka, IN 46545-1469
Phone (574) 335-5000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200922330 | Medicaid | IN | |
| 000000593395 | Other | IN | ANTHEM |
| P00671030 | Other | IN | RR MEDICARE |
| 930005546 | Other | MI | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101009164 | MI | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Ascension Borgess Hospital | Current | Accepting new patients | |
| Rosebud Indian Health Service | Current | Accepting new patients | |
| Rosebud Indian Health Service | Current | Accepting new patients | |
| PHS Indian Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Emergency Care Specialists PC | Emergency Medicine | Past | Accepting new patients |
Locations
1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165
Organizations & group practices 8
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.
-
- General Acute Care Hospital
- Kalamazoo, MI
- NPI 1568416311
-
- General Acute Care Hospital
- Pine Ridge, SD
- NPI 1497786412
TX
-
- Clinic/Center
- Martin, SD
- NPI 1003208257
-
- Clinic/Center
- Wanblee, SD
- NPI 1962559518
-
- Ambulatory Surgical Clinic/Center
- Rosebud, SD
- NPI 1790955128
-
- Emergency Medicine Physician
- Grand Rapids, MI
- NPI 1093766958
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323993600000",
"number": "1639223605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5215 HOLY CROSS PKWY",
"address_2": "EMERGENCY DEPARTMENT",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451469",
"telephone_number": "574-335-5000",
"fax_number": "574-273-1137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5215 HOLY CROSS PKWY",
"address_2": "EMERGENCY DEPARTMENT",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451469",
"telephone_number": "574-335-5000",
"fax_number": "574-273-1137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DREW",
"first_name": "GEORGE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2011-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "5101009164",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "02003439",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200922330",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000593395",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00671030",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "930005546",
"state": "MI"
}
],
"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 Dec 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.