Martin Julius Andersen, DO
Individual provider Active NPI Nephrology Physician · Avon, IN
NPI 1669406237 · NPPES record last updated Mar 5, 2025
Key facts
- NPI
- 1669406237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 02003131A (IN)
- Practice address
- 1115 Ronald Reagan Pkwy Ste 206
Avon, IN 46123-6911 - Phone
- (317) 217-2200
- Fax
- (317) 217-2205
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Iu Health Medical Group LLC
Practice addresses (Care Compare)
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258
Hospital & facility affiliations
- DaVita Westview Dialysis
- DaVita Avon Dialysis
- Iu Health West Hospital
- Indiana University Health
- Indiana University Health North Hospital
- Hendricks Regional Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070207000506 | IN | Practitioner - Nephrology | 5496752818 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02003131A | IN | MD | Internal Medicine Physician |
| 200600754 | NC | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iu Health Medical Group, LLC | Current |
Accepting new patients | |
| University Medical Diagnostic Associates, Inc. | Internal Medicine | Current |
Accepting new patients |
| Major Hospital | Past | Accepting new patients | |
| Hickory Internal Medicine, Hypertension & Renal Associates | Past | Accepting new patients |
Locations
7301 Solutions Ctr
Chicago, IL 60677
1115 Ronald Reagan Pkwy
Ste 141
Avon, IN 46123
Phone (317) 217-2700
1115 Ronald Reagan Pkwy
Ste 206
Avon, IN 46123
Phone (317) 217-2888
535 Barnhill Dr
#150
Indianapolis, IN 46202
Phone (317) 274-5292
250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174
550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000
1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754
250 N Shadeland Ave
Ste 200
Indianapolis, IN 46219
Phone (317) 962-4836
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 200600754 | NC | |
| Internal Medicine Physician | 207R00000X | 02003131A | IN | |
| Nephrology Physician | 207RN0300X | 02003131A | IN | Yes |
Addresses
Primary practice location
1115 Ronald Reagan Pkwy Ste 206
Avon, IN 46123-6911
Mailing address
250 N Shadeland Ave
Indianapolis, IN 46219-4959
Other practice location 1
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200843770 | Medicaid | IN | |
| 200600754 | Other | NC | N.C, MEDICAL BOARD |
| 000000509680 | Other | IN | ANTHEM PTAN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | manderse@direct.iuhealth.org | ||
| Direct Messaging Address | manderse@direct.iuhealth.org | Direct |
Other providers in Avon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.