Individual provider Active NPI

Scott Carl Miethke, MD

  • Internal Medicine Physician
  • Lafayette, IN
National Provider Identifier
1689643397
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01038378A Issued in IN
Practice address
2600 Greenbush St
Lafayette, IN 47904-2477
Phone
(765) 448-8000
Fax
(765) 448-7627
NPI assigned
Mar 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01038378A IN Primary

Addresses

Primary practice location

2600 Greenbush St
Lafayette, IN 47904-2477

Mailing address

1200 W White River Blvd
Muncie, IN 47303-4988
Phone (877) 668-5621

Other practice location 1

253 Sagamore Pkwy W
West Lafayette, IN 47906-1501
Phone (765) 448-8000

Other identifiers 4

IdentifierTypeStateIssuer
E43782OtherINMEDICARE UPIN NUMBER
000000185176OtherINANTHEM PROVIDER NUMBER
100262390MedicaidIN
MI91990011MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address miethkes@direct.iuhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20081006000328 IN Practitioner - Internal Medicine 9830267756 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01038378AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arnett Clinic, LLC Internal Medicine CurrentSince Aug 1, 2008 Accepting new patients
Arnett Clinic, LLC CurrentSince Aug 1, 2008 Accepting new patients
Arnett Clinic, LLC Current Accepting new patients

Locations

8016 Reliable Pkwy
Chicago, IL 60686

2600 Greenbush St
Lafayette, IN 47904

1200 W White River Blvd
Muncie, IN 47303
Phone (765) 254-4009

253 Sagamore Pkwy W
West Lafayette, IN 47906

Interoperability endpoints

  • Direct secure messaging: miethkes@direct.iuhealth.org

Organizations & group practices 3

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": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1689643397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W WHITE RIVER BLVD",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473034988",
            "telephone_number": "877-668-5621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 GREENBUSH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042477",
            "telephone_number": "765-448-8000",
            "fax_number": "765-448-7627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "253 Sagamore Pkwy W",
            "address_purpose": "LOCATION",
            "city": "West Lafayette",
            "state": "IN",
            "postal_code": "479061501",
            "country_code": "US",
            "telephone_number": "765-448-8000",
            "fax_number": "765-448-7605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIETHKE",
        "first_name": "SCOTT",
        "middle_name": "CARL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01038378A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE UPIN NUMBER",
            "identifier": "E43782",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000185176",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262390",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MI91990011",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "miethkes@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "2600 Greenbush St",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479042477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.