Edward J Bastyr III, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

01044193A Issued in IN

Practice address

720 Eskenazi Ave
University Medical Diagnostic Associates, Inc.
Indianapolis, IN 46202-5166

Phone

(317) 880-5045

Fax

(317) 880-0414

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537

  Endocrinology, Diabetes & Metabolism

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1831266154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE.",
            "address_2": "SUITE 130",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959",
            "telephone_number": "317-823-9357",
            "fax_number": "317-823-9357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 ESKENAZI AVE",
            "address_2": "UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES, INC.",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025166",
            "telephone_number": "317-880-5045",
            "fax_number": "317-880-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTYR",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IN",
            "license": "01044193A",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IN",
            "license": "01044193A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201291380",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebastyr13747@direct.eskenazihealth.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "720 Eskenazi Ave",
            "address_2": "University Medical Diagnostic Associates, Inc.",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462025166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Richard James Bastian, MD
• Beth Ann Bastien, PSYCHOLOGIST
• Brooke Bastin
• Abigail Bastnagel
• James P Bastnagel, MD
• Maite Bastyr, MD
• Rohan Basu, MD
• Ashley Batchelor-Nasiri
• Kelly Marie Batchelor
• Christian Pearson Bateman, MD

• All providers in Indianapolis, IN
• Endocrinology, Diabetes & Metabolism Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.