NPIMap

Individual provider Active NPI

Michael M Bermudez, MD

  • Emergency Medicine Physician
  • Portage, IN
National Provider Identifier
1649213554
Registry record updated Jul 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101241235 Issued in VA
Practice address
3630 Willowcreek Rd
Portage, IN 46368-5075
Phone
(219) 364-3000
NPI assigned
Jun 14, 2006
Last updated
Jul 7, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2008

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01061935A IN
Emergency Medicine Physician 207P00000X 36266 AZ
Emergency Medicine Physician 207P00000X 208568 NY
Emergency Medicine Physician 207P00000X 0101241235 VA Primary

Addresses

Primary practice location

3630 Willowcreek Rd
Portage, IN 46368-5075

Mailing address

149 Rainbow Drive #4918
Livingston, TX 77399-1049
Phone (316) 841-4324

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36266AZMDEmergency Medicine Physician
01061935AINMDEmergency Medicine Physician
208568NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Vanderburgh County, PC Emergency Medicine Past Accepting new patients
St. Vincent's Midtown Hospital Past Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Major Hospital Past Accepting new patients
Midwest Emergency Associates-Munster, LLC Emergency Medicine Past Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Via Christi Emergency Physician Services, LLC Emergency Medicine Past Accepting new patients
Columbia Healthcare of Central Virginia Inc PastSince Apr 1, 2019 Accepting new patients
NM Heart Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Riverside Physician Services, Inc. Emergency Medicine Past Accepting new patients
Emergency Services, PA Emergency Medicine Past Accepting new patients
Health Care Alliance, Inc. Emergency Medicine Past Accepting new patients
KHH Emergency Medicine Emergency Medicine Past Accepting new patients
Marshall West Virginia Ed Associates, LLC Emergency Medicine Past Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Brookdale Hospital Medical Center Past Accepting new patients

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1649213554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 RAINBOW DRIVE #4918",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773991049",
            "telephone_number": "316-841-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685075",
            "telephone_number": "219-364-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMUDEZ",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01061935A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "36266",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "208568",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101241235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.