NPIMap

Organization Active NPI

Community Open MRI of Auburn LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1023201316
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
COMMUNITY OPEN MRI OF AUBURN LLC
Practice address
2428 Lake Ave
Fort Wayne, IN 46805-5406
Phone
(260) 422-1491
Fax
(260) 423-1421
NPI assigned
Aug 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Mr. John Steven Platusic
Title
Coo
Phone
(804) 363-1007

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

2428 Lake Ave
Fort Wayne, IN 46805-5406

Mailing address

2428 Lake Ave
Fort Wayne, IN 46805-5406
Phone (260) 422-1491

Other identifiers 1

IdentifierTypeStateIssuer
200414630AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071204000024 IN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9234100256 Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Community Open MRI of Auburn LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2428 Lake Ave
Fort Wayne, IN 46805
Phone (260) 422-1491

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1023201316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055406",
            "telephone_number": "260-422-1491",
            "fax_number": "260-423-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055406",
            "telephone_number": "260-422-1491",
            "fax_number": "260-423-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY OPEN MRI OF AUBURN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "PLATUSIC",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "804-363-1007",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200414630A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.