ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC. (NPI# 1023203239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023203239 |
| Entity Type | Organization |
| Organization Name | ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC. |
| Other Organization Name | ST. VINCENT PEDIATRIC SUBSPECIALTIES |
| Practice Address |
2200 Randallia Dr Fort Wayne IN 46805-4638 |
| Mailing Address |
10330 N Meridian St Suite 201 Indianapolis IN 46290-1024 |
| Practice Telephone | 8007278439 |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2008-05-01 |
| Authorized Official Name | D. BRUCE HAGA (VICE PRESIDENT) |
| Authorized Official Telephone | 3175833087 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080P0216X |
Pediatrics Specialization: Pediatric Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207VM0101X |
Obstetrics & Gynecology Specialization: Maternal & Fetal Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200505130W | 05 |
| Other Name | Type Code |
|---|---|
| ST. VINCENT PEDIATRIC SUBSPECIALTIES | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174866156 | St. Vincent Hospital and Health Care Center, Inc. | Preventive Medicine | 4800 S 975 E, Zionsville, IN 46077-8252 | 2013-03-28 |
| 1316205495 | St. Vincent Hospital and Health Care Center, Inc. | Pediatrics | 8402 Harcourt Rd, Suite 402, Indianapolis, IN 46260-2074 | 2012-04-26 |
| 1508159732 | St. Vincent Hospital and Health Care Center, Inc. | Physical Therapist | 8227 Northwest Blvd, Suite 160, Indianapolis, IN 46278-1387 | 2011-05-20 |
| 1184803611 | St. Vincent Hospital and Health Care Center, Inc. | Psychologist | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2007-11-01 |
| 1083781892 | St. Vincent Hospital and Health Care Center, Inc. | General Acute Care Hospital | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2006-11-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC. | 2001 W 86th St, Po Box 40970, Indianapolis, IN 46260 |
| Street Address |
2200 RANDALLIA DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972508471 | Matthew Paul Ziccardi | Clinical Neuropsychologist | 2200 Randallia Dr, Fort Wayne, IN 46805 | 2005-06-20 |
| 1891308896 | Cameron Buzzard | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-08-28 |
| 1558985945 | Morgan Taylor Hilbert | Pharmacist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-06-02 |
| 1952941908 | Lydia Hentz | Counselor | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-01-07 |
| 1326683228 | Nicole Marie Gaunt | Social Worker | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-11-14 |
| 1205490877 | Elisha Lynn Handshoe | Physical Medicine & Rehabilitation | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-29 |
| 1154884898 | Monique Brissette | Speech-Language Pathologist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-10 |
| 1649733411 | Clarissa Burkett | Physical Therapy Assistant | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| 1740743533 | Ross Tyler Nelson | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| 1295298982 | Jennifer Ferguson | Occupational Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730234071 | Northern Indiana Neonatal Associates, PC | Pediatrics | 3221 Covington Lake Dr, Fort Wayne, IN 46804-2515 | 2007-01-25 |
| 1104950799 | Win Boon | Pediatrics | 11115 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2007-03-15 |
| 1205980208 | Christopher Kim | Pediatrics | 7950 W Jefferson Blvd, Neonatal Intensive Care Unit, Fort Wayne, IN 46804-4140 | 2007-01-23 |
| 1568515567 | Rene C. Arcellana | Pediatrics | 7950 W Jefferson Blvd, Neonatal Intensive Care Unit, Fort Wayne, IN 46804-4140 | 2007-01-21 |
| 1649322645 | Janet L. Leezer | Pediatrics | 7950 W Jefferson Blvd, Neonatal Intensive Care Unit, Fort Wayne, IN 46804-4140 | 2007-01-18 |
| 1669524732 | James E. Cameron | Pediatrics | 7950 W Jefferson Blvd, Neonatal Intensive Care Unit, Fort Wayne, IN 46804-4140 | 2007-01-17 |
| 1245381607 | Daniel A. Biehl | Pediatrics | 7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2007-01-14 |
| 1326099334 | Alston Michael Porter | Pediatrics | 11115 Parkview Plaza Dr, Dept. of Neonatology, Fort Wayne, IN 46845-1701 | 2006-05-14 |
| 1134185382 | Felix A Okah | Pediatrics | 7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2006-04-25 |
| 1639133127 | Candace C Caldwell | Pediatrics | 11115 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2006-04-13 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.