Individual provider Active NPI

George R Drew, DO

  • Emergency Medicine Physician
  • Mishawaka, IN
National Provider Identifier
1639223605
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02003439 Issued in IN
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

Updated by the provider on Dec 16, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
200922330MedicaidIN
000000593395OtherINANTHEM
P00671030OtherINRR MEDICARE
930005546OtherMIRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070619000112 MI Practitioner - Emergency Medicine 2769370477 Reassigns benefits to 1 organization
I20200930001344 TX Practitioner - Internal MedicinePractitioner - Emergency Medicine 2769370477 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101009164MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Ridge Indian Health Service Hospital CurrentSince Aug 18, 2020 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Ascension Borgess Hospital Current Accepting new patients
Rosebud Indian Health Service CurrentSince Oct 11, 2020 Accepting new patients
Rosebud Indian Health Service CurrentSince Oct 11, 2020 Accepting new patients
PHS Indian Hospital CurrentSince Jun 21, 2022 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Aug 18, 2020 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.

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

Verify at the official NPI Registry.