FORT WAYNE ORTHOPEDICS, LLC (NPI# 1811202963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811202963 |
| Entity Type | Organization |
| Organization Name | FORT WAYNE ORTHOPEDICS, LLC |
| Practice Address |
3816 New Vision Dr Fort Wayne IN 46845-1708 |
| Mailing Address |
Po Box 2526 Fort Wayne IN 46801-2526 |
| Practice Telephone | 2604368686 |
| Practice Fax Number | 2604590036 |
| Mailing Telephone | 2604368686 |
| Mailing Fax Number | 2604325075 |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2013-11-27 |
| Authorized Official Name | JERALD L. COOPER (M.D./PRESIDENT) |
| Authorized Official Telephone | 2604368686 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XS0106X |
Orthopaedic Surgery Specialization: Hand Surgery |
50002482 | IN | Allopathic & Osteopathic Physicians |
| N | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
50002482 | IN | Allopathic & Osteopathic Physicians |
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
50002482 | IN | Allopathic & Osteopathic Physicians |
| N | 207XX0801X |
Orthopaedic Surgery Specialization: Orthopaedic Trauma |
50002482 | IN | Allopathic & Osteopathic Physicians |
| N | 213E00000X | Podiatrist | 50002482 | IN | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
50002482 | IN | Podiatric Medicine & Surgery Service Providers |
| N | 363A00000X | Physician Assistant | 50002482 | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207X00000X | Orthopaedic Surgery | 50002482 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | DME PTAN | 0162610007 | 01 |
| IN | 100210470 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043525009 | Fort Wayne Orthopedics, LLC | Orthopaedic Surgery | 315 W Old Key Dr, Suite 140, Peru, IN 46970-9058 | 2010-08-16 |
| 1881909935 | Fort Wayne Orthopedics, LLC | Orthopaedic Surgery | 207 N Townline Rd, Lagrange, IN 46761-1325 | 2010-08-13 |
| 1518272665 | Fort Wayne Orthopedics, LLC | Orthopaedic Surgery | 816 Main St, Rochester, IN 46975-1543 | 2010-08-13 |
| 1184939233 | Fort Wayne Orthopedics, LLC | Orthopaedic Surgery | 315 Lehman Ave, Topeka, IN 46571-9476 | 2010-08-13 |
| Street Address |
3816 NEW VISION DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845-1708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164630596 | Linda Katherine Vukovich | Nurse Practitioner | 3816 New Vision Dr, Fort Wayne, IN 46845-1708 | 2007-05-18 |
| 1447731302 | Regina Frederick | Nurse Practitioner | 3816 New Vision Dr, Fort Wayne, IN 46845-1708 | 2018-08-28 |
| 1912233867 | Parkview Health System, Inc. | Internal Medicine | 3816 New Vision Dr, Fort Wayne, IN 46845-1708 | 2009-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| Find all providers in zip 46845 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861774838 | Paul Arthur Reszel | Orthopaedic Surgery | 1618 Autumn Run, Fort Wayne, IN 46845-8884 | 2011-09-15 |
| 1073505301 | William H Couch | Orthopaedic Surgery | 5050 N Clinton Street, Fort Wayne, IN 46825 | 2005-08-23 |
| 1366445421 | Ronald G Caldwell | Orthopaedic Surgery | 413 E Jefferson Blvd, Matthew 25 Health and Dental Clinic, Fort Wayne, IN 46802-3201 | 2005-05-23 |
| 1255750352 | Fort Wayne Orthopaedics, LLC | Orthopaedic Surgery | 800 Broadway, Ste 215, Fort Wayne, IN 46802-2149 | 2014-04-16 |
| 1649534256 | James Michael Danias | Orthopaedic Surgery | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2012-06-28 |
| 1326311481 | Phillip Craig Penny I | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2012-02-20 |
| 1427345982 | Christopher N Johnson | Orthopaedic Surgery | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2011-07-06 |
| 1043506694 | John Paul Magno Manalo | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2011-06-22 |
| 1487959649 | Kevin John Leffers | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2011-01-20 |
| 1871808923 | Fort Wayne Orthopaedics, LLC | Orthopaedic Surgery | 2512 E Dupont Rd, Suite 110, Fort Wayne, IN 46825-1609 | 2010-08-13 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
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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.