FORT WAYNE CARDIOLOGY CORPORATION (NPI# 1669458733) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669458733 |
| Entity Type | Organization |
| Organization Name | FORT WAYNE CARDIOLOGY CORPORATION |
| Practice Address |
11558 Sr 111 Paulding OH 45879 |
| Mailing Address |
Po Box 11829 Fort Wayne IN 46861-1829 |
| Practice Telephone | 2604814700 |
| Practice Fax Number | 2604814808 |
| Mailing Telephone | 2604814700 |
| Mailing Fax Number | 2604814808 |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2008-10-07 |
| NPI Deactivation Date | 08/09/2007 |
| NPI Reactivation Date | 2007-10-11 |
| Authorized Official Name | DR. RAYMOND DUSMAN (CEO) |
| Authorized Official Telephone | 2604814700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | FORT WAYNE CARDIOLOGY CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200425420M | 05 | |
| OH | RR MEDICARE | CK8615 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134318355 | Fort Wayne Cardiology Corporation | Internal Medicine | 1819 Carew St, Fort Wayne, IN 46805-4705 | 2007-10-24 |
| 1609852292 | Fort Wayne Cardiology Corporation | Internal Medicine | 1819 Carew St, Fort Wayne, IN 46805-4705 | 2005-12-16 |
| 1730165242 | Fort Wayne Cardiology Corporation | Internal Medicine | 208 Columbus St, Hicksville, OH 43526 | 2005-12-16 |
| Street Address |
11558 SR 111 |
| City | PAULDING |
| State | OH |
| Zip Code | 45879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922484427 | Jenna Mae Sherry | Physical Therapist | 202 N.cherry St., Western Buckeye Esc, Paulding, OH 45879 | 2015-08-06 |
| 1255620696 | Elizabeth Gilbert | Occupational Therapy Assistant | 14601 Rd 115, Paulding, OH 45879 | 2011-04-06 |
| 1053505339 | Westwood Behavioral Health Center, Inc. | Clinic/Center | 501 Mc Donald Pike, Paulding, OH 45879 | 2007-08-30 |
| 1417098997 | William Max Miller | Family Medicine | 602 Emerald Road, Paulding, OH 45879 | 2007-02-09 |
| 1063573939 | Don Kimsey Snyder | Family Medicine | 1030 West Wayne St, Paulding, OH 45879 | 2006-12-13 |
| 1376511568 | Paulding County Hospital | Home Health | 835 N Williams St, Paulding, OH 45879 | 2006-03-14 |
| 1487646865 | Paulding Counseling Center | Counselor | 501 Mcdonald Pike, Paulding, OH 45879 | 2005-08-22 |
| 1215553235 | Gardens At Paulding Operating Company, LLC | Skilled Nursing Facility | 199 County Road 103, Paulding, OH 45879 | 2020-06-25 |
| 1215407879 | Beth R Billips | Case Manager/Care Coordinator | 501 Mcdonald Pike, Paulding, OH 45879 | 2018-11-27 |
| 1265950133 | Andrea Renee Ricker | Social Worker | 501 Mc Donald Pike, Paulding, OH 45879 | 2017-08-31 |
| Find all providers in zip 45879 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
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| 1316504723 | Olivia Kay Preston | Internal Medicine | 543 Taylor Ave Ste 3002, Columbus, OH 43203-1278 | 2019-05-21 |
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| 1982168100 | Optimum Cardiology Inc | Internal Medicine | 4825 Higbee Ave Nw Ste 102, Canton, OH 44718-2567 | 2019-01-23 |
| 1053859124 | Andrew Michael Dominic Crean | Internal Medicine | Division of Cardiovascular Health And, 231 Albert Sabin Way, Cincinnati, OH 45267-0001 | 2017-02-08 |
| 1306393541 | Lima Memorial Professional Corporation | Internal Medicine | 140 Fox Rd Ste 103 1/2, Van Wert, OH 45891-3400 | 2016-09-06 |
| 1699221234 | Hatem Mowafy I | Internal Medicine | 12 Avenue Street Ross Hear Hospital, Columbus, OH 43202 | 2016-09-01 |
| 1720432693 | Radoslav Zinoviev | Internal Medicine | 9500 Euclid Ave Rm J3-6, Cleveland, OH 44195-3220 | 2016-04-18 |
| 1053773838 | Dayton Springfield Heart and Vascular Medicine, LLC | Internal Medicine | 7111 N. Main St., Suite 50, Dayton, OH 45415-2558 | 2016-03-22 |
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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.