Miles Burton Andrew, M.D.
Individual provider Active NPI Dermatology Physician · Mishawaka, IN
NPI 1689692188 · NPPES record last updated Sep 14, 2016
Key facts
- NPI
- 1689692188
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 01040450A (IN)
- Practice address
- 230 E Day Rd
Suite 130
Mishawaka, IN 46545-3408 - Phone
- (574) 335-7650
- Fax
- (574) 335-0736
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- University of Wisconsin School of Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The South Bend Clinic LLC
Practice addresses (Care Compare)
211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 234-8161
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 713 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 19 |
| Skin biopsy | 127 |
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 |
|---|---|---|---|---|
| I20040629000586 | IN | Practitioner - Dermatology |
3173509106 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01040450A | IN | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Applegarth Dermatology PC | Current |
Accepting new patients | |
| The South Bend Clinic, LLC | Current |
Accepting new patients | |
| The South Bend Clinic LLC | Current |
Accepting new patients | |
| Applegarth Dermatology PC | Past |
Accepting new patients |
Locations
611 E Douglas Rd
Ste 310
Mishawaka, IN 46545
Phone (574) 335-6770
611 E Douglas Rd
Ste 408
Mishawaka, IN 46545
Phone (574) 335-6440
611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232
230 E Day Rd
Ste 130
Mishawaka, IN 46545
Phone (574) 247-4667
2102 E Inwood Rd
South Bend, IN 46614
Phone (574) 204-6000
211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331
1861 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 548-0360
Interoperability endpoints
- mandrew252496@dulyhealthandcare.direct-ci.com
- https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 01040450A | IN | Yes |
Addresses
Primary practice location
230 E Day Rd
Suite 130
Mishawaka, IN 46545-3408
Mailing address
707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100380840A | Medicaid | IN | |
| 100380840 | Medicaid | IN | |
| 000000889511 | Other | IN | BCBS |
Other providers in Mishawaka, IN
- Alexandria Anderson
- Andrew R Anderson
- Jane Elizabeth Anderson
- Kiesha Anderson
- Jessica Andreen
- Gregory Andrianov
- Hari Priya Anne
- Christy Lynn Annis
- Bilal Ansari
- Muhammad Shahzad Mumtaz Ansari
All providers in Mishawaka, IN · Dermatology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2016. 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.