NPIMap

Organization Active NPI

Orthopaedics Northeast PC

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
National Provider Identifier
1043270002
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
ORTHOPAEDICS NORTHEAST PC
Practice address
8202 Glencarin Blvd Ste 300
Fort Wayne, IN 46804-5783
Phone
(260) 484-8551
Fax
(260) 484-9603
NPI assigned
Mar 24, 2006
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Raymond Kusisto
Title
Ceo
Phone
(260) 484-8551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

8202 Glencarin Blvd Ste 300
Fort Wayne, IN 46804-5783

Mailing address

5050 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 484-8551

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930069900 IN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9234024878 Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Surgery One13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1043270002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-484-8551",
            "fax_number": "260-484-9603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8202 GLENCARIN BLVD STE 300",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045783",
            "telephone_number": "260-484-8551",
            "fax_number": "260-484-9603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDICS NORTHEAST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "KUSISTO",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-484-8551"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Mar 27, 2025; 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.