Daniel Abraha, MD
Individual provider Active NPI Pediatric Critical Care Medicine Physician · Fort Wayne, IN
NPI 1063419166 · NPPES record last updated Sep 23, 2020
Key facts
- NPI
- 1063419166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Critical Care Medicine Physician 2080P0203X
- License
- 01061925A (IN)
- Practice address
- 7950 W Jefferson Blvd
Suite 210
Fort Wayne, IN 46804-4140 - Phone
- (260) 435-7355
- Fax
- (260) 435-7637
- NPI assigned
- Jul 5, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061226000041 | IN | Practitioner - Pediatric Medicine |
3779565858 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Medical Group LLC | Current |
Accepting new patients | |
| Lutheran Medical Group LLC | Current |
Accepting new patients |
Locations
7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088
3534 Brooklyn Ave
Fort Wayne, IN 46809
Phone (219) 478-5180
7950 W Jefferson Blvd
Ste 210
Fort Wayne, IN 46804
Phone (260) 435-7355
6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514
2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076
Interoperability endpoints
- daniel.abraha@lutheranhealthnetwork.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | 01061925A | IN | Yes |
Addresses
Primary practice location
7950 W Jefferson Blvd
Suite 210
Fort Wayne, IN 46804-4140
Mailing address
6920 Pointe Inverness Way Ste 200
Fort Wayne, IN 46804-7934
Phone (260) 479-3516
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200816520 | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | daniel.abraha@lutheranhealthnetwork.cernerdirect.com |
Other providers in Fort Wayne, IN
- Aboite Health Center, Inc.
- Aboite Podiatry Associates PC
- Aboite Township Fire Dept in
- Ibrahim H Abou Daya
- Above and Beyond ABA in LLC
- Brice Boby Abraham
- Sean Alexander Abraham
- Daniel Abreu
- Griselda Abreu
- Absolute Pain Management, LLC
All providers in Fort Wayne, IN · Pediatric Critical Care Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.