Active NPI
Gregory Mellinger, PA
- Physician Assistant
- Warsaw, IN
National Provider Identifier
1679763437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 99027179A
- Practice address
- 1500 Provident Dr
Suite a
Warsaw, IN 46580-3291 - Phone
- (574) 372-5823
- NPI assigned
- Jul 27, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 99027179A | IN | Primary |
Addresses
Primary practice location
1500 Provident Dr
Suite a
Warsaw, IN 46580-3291
Mailing address
1500 Provident Dr
Suite a
Warsaw, IN 46580-3291
Phone (574) 372-5823
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000592337 | Other | ANTHEM |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99027179A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodlawn Hospital | Past | Accepting new patients |
Organizations & group practices 1
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": "1185494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200355200000",
"number": "1679763437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 PROVIDENT DR",
"address_2": "SUITE A",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803291",
"telephone_number": "574-372-5823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 PROVIDENT DR",
"address_2": "SUITE A",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803291",
"telephone_number": "574-372-5823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLINGER",
"first_name": "GREGORY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-27",
"last_updated": "2008-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "99027179A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000592337",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Warsaw, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.