Northeast Medical Associates, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

50004246A Issued in IN

Legal business name

NORTHEAST MEDICAL ASSOCIATES, PC

Practice address

1234 E. Dupont Rd.
Suite 6
Fort Wayne, IN 46825-1545

Phone

(260) 480-2600

Fax

(260) 496-8077

NPI assigned

Nov 1, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Karen Sue Evans, M.D.

Title

Physician

Phone

(260) 480-2600

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JFACCA

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura Michelle Ingrum, NP-C

  • Nurse Practitioner
  • Washington, DC
  • NPI 1295726859
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1003807850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 E. DUPONT RD.",
            "address_2": "SUITE 6",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251545",
            "telephone_number": "260-480-2600",
            "fax_number": "260-496-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 E. DUPONT RD.",
            "address_2": "SUITE 6",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251545",
            "telephone_number": "260-480-2600",
            "fax_number": "260-496-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "260-480-2600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "50004246A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1003807850",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "7795314",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200335790A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CJ8803",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northeast Indiana Pediatric Specialists, PC
• Northeast Indiana Urology PC
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• Northeast Indiana Urology. P.C.
• Northeast Obstetrics & Gynecology, LLC
• Northeast Obstetrics & Gynecology, LLC
• Northeast Obstetrics & Gynecology, LLC
• Northeast Ophthalmology P C
• Northeast Ophthalmology P C

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.