NPIMap

Michael M Bermudez, MD

Individual provider Active NPI Emergency Medicine Physician · Portage, IN

NPI 1649213554 · NPPES record last updated Jul 7, 2008

Key facts

NPI
1649213554
Entity type
Individual (NPI type 1)
Primary specialty
Emergency Medicine Physician 207P00000X
License
0101241235 (VA)
Practice address
3630 Willowcreek Rd
Portage, IN 46368-5075
Phone
(219) 364-3000
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
Yes

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 and National Provider Directory roles.

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
Yes
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
Brookdale Hospital Medical Center Past Accepting new patients
Major Hospital Past Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Marshall West Virginia Ed Associates, LLC Emergency Medicine Past Accepting new patients
Midwest Emergency Associates-Munster, LLC Emergency Medicine Past Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Health Care Alliance, Inc. 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
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Columbia Healthcare of Central Virginia Inc Past
since Apr 1, 2019		 Accepting new patients
KHH Emergency Medicine Emergency Medicine Past Accepting new patients
NM Heart Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Via Christi Emergency Physician Services, LLC Emergency Medicine Past Accepting new patients
St. Vincent'S Midtown Hospital Past Accepting new patients

Specialties & licenses

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 Yes

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

Other identifiers

IdentifierTypeStateIssuer
1649213554MedicaidVA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 7, 2008.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649213554",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

All providers in Portage, IN · Emergency Medicine Physician in Indiana

Sources for this page

Verify at the official NPI Registry.