Active NPI
Richard Mason Storm, M.D.
- Procedural Dermatology Physician
- Greenwood, IN
National Provider Identifier
1922003086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- License
- 01029002A
- Practice address
- 622 N Madison Ave
Ste 5
Greenwood, IN 46142-4052 - Phone
- (317) 743-8930
- Fax
- (317) 743-8937
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Procedural Dermatology Physician | 207NS0135X | 01029002A | IN | Primary |
Addresses
Primary practice location
622 N Madison Ave
Ste 5
Greenwood, IN 46142-4052
Mailing address
622 N Madison Ave
Ste 5
Greenwood, IN 46142-4052
Phone (317) 743-8930
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15D0352826 | Other | IN | CLIA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01029002A | IN | MD | Procedural Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major 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.
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480377600000",
"number": "1922003086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 N MADISON AVE",
"address_2": "STE 5",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461424052",
"telephone_number": "317-743-8930",
"fax_number": "317-743-8937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 N MADISON AVE",
"address_2": "STE 5",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461424052",
"telephone_number": "317-743-8930",
"fax_number": "317-743-8937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STORM",
"first_name": "RICHARD",
"middle_name": "MASON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2016-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "IN",
"license": "01029002A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "15D0352826",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.