NORTHEAST INDIANA GENETICS, LLC (NPI# 1356764419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356764419 |
| Entity Type | Organization |
| Organization Name | NORTHEAST INDIANA GENETICS, LLC |
| Practice Address |
7230 Engle Rd Fort Wayne IN 46804-2209 |
| Practice Telephone | 2604823886 |
| Practice Fax Number | 2604821910 |
| Mailing Telephone | 2604823886 |
| Mailing Fax Number | 2604821910 |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2018-01-31 |
| Authorized Official Name | MR. JOSEPH BADER (OFFICE MANAGER) |
| Authorized Official Telephone | 2604823886 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | PHYSICIAN MEDICAL LICENSING | 01022953A | 01 |
| Street Address |
7230 ENGLE RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-2209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043283641 | Jason T. Cook | Psychologist | 7230 Engle Rd, Ste 304, Fort Wayne, IN 46804-2209 | 2006-02-13 |
| 1275187551 | Leeann Christine Shondell | Registered Nurse | 7230 Engle Rd, Fort Wayne, IN 46804-2209 | 2019-07-25 |
| 1619357779 | Chung Ning Tan | Family Medicine | 7230 Engle Rd, Fort Wayne, IN 46804 | 2015-06-04 |
| 1841478336 | Patricia I Bader | Medical Genetics | 7230 Engle Rd, Suite 140, Fort Wayne, IN 46804-2234 | 2008-02-06 |
| 1467630061 | Deborah S Baker | Nurse Practitioner | 7230 Engle Rd, Suite 140, Fort Wayne, IN 46804-2234 | 2008-02-06 |
| 1588864912 | Viktoriya Y. Pleshkan | Registered Nurse | 7230 Engle Rd, Suite 210, Fort Wayne, IN 46804-2209 | 2007-07-24 |
| 1558416883 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 7230 Engle Rd, Suite 301, Fort Wayne, IN 46804-2209 | 2007-01-25 |
| 1982710851 | Decatur Vein Clinic, PC | Phlebology | 7230 Engle Rd, Suite 101, Fort Wayne, IN 46804-2209 | 2006-08-22 |
| 1548205057 | Dennis C. Uhrhammer | Family Medicine | 7230 Engle Rd, Fort Wayne, IN 46804 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841478336 | Patricia I Bader | Medical Genetics | 7230 Engle Rd, Suite 140, Fort Wayne, IN 46804-2234 | 2008-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174751218 | Zineb Abdelkarim Ammous | Medical Genetics | 315 Lehman Ave, #c, Topeka, IN 46571-9476 | 2009-06-27 |
| 1942488754 | Northwest Center Medical Services Corp. | Medical Genetics | 3400 Broadway, Gary, IN 46408-1101 | 2008-02-04 |
| 1861572117 | Brett Harrison Graham | Medical Genetics | 550 University Blvd, Iuhp Medical & Molecular Genetics, Aoc Suite 5001, Indianapolis, IN 46202 | 2006-10-17 |
| 1154431567 | Bryan E Hainline | Medical Genetics | 975 W Walnut St, Indianapolis, IN 46202-5181 | 2006-08-30 |
| 1174555999 | Stephanie M Ware | Medical Genetics | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2006-07-06 |
| 1831120229 | Bradley T Tinkle | Medical Genetics | 8402 Harcourt Rd Ste 300, Indianapolis, IN 46260-2052 | 2006-07-05 |
| 1780637058 | Indiana University Medical Genetics Service, Inc. | Medical Genetics | 975 W Walnut St, Indianapolis, IN 46202-5181 | 2006-05-18 |
| 1508822545 | David D Weaver | Medical Genetics | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2006-04-26 |
| 1487610051 | Wilfredo Torres-martinez | Medical Genetics | 975 W Walnut St, Ib 130, Indianapolis, IN 46202-5181 | 2006-04-24 |
| City | FORT WAYNE |
| Zip Code | 46804 |
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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.