NPIMap

Individual provider Active NPI

Praveen Kollipara, MD

  • Hematology & Oncology Physician
  • Fort Wayne, IN
National Provider Identifier
1073515987
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
01046718A Issued in IN
Practice address
7910 W Jefferson Blvd Ste 108
Fort Wayne, IN 46804-4159
Phone
(260) 484-8830
Fax
(260) 483-1911
NPI assigned
Aug 10, 2005
Last updated
May 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 01046718A IN Primary
Medical Oncology Physician 207RX0202X 01046718A IN

Addresses

Primary practice location

7910 W Jefferson Blvd Ste 108
Fort Wayne, IN 46804-4159

Mailing address

PO Box 749495
Atlanta, GA 30374-9495
Phone (855) 963-2100

Other identifiers 4

IdentifierTypeStateIssuer
000000693537OtherINANTHEM
000000083727OtherINANTHEM
200148280MedicaidIN
3045547MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100519000479 IN Practitioner - Hematology/Oncology 3577455070 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Oncology Partners PAGroup PAC ID 0042569758, 377 clinicians
Fort Wayne Medical Oncology and Hematology IncGroup PAC ID 2961394440, 2 clinicians

Practice addresses (Care Compare)

2514 E Dupont Rd
Suite 100
Fort Wayne, IN 46825-1619
Phone (260) 484-8830

7910 W Jefferson Blvd
Suite 108
Fort Wayne, IN 46804-4159
Phone (260) 484-8830

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.69 of 100Reported as group
Quality
86.47
Promoting interoperability
81
Improvement activities
40
Cost
60.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01046718AINMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Oncology Partners PA Hematology & Oncology CurrentSince Jan 2, 2025 Accepting new patients
Fort Wayne Medical Oncology and Hematology, Inc Hematology & Oncology CurrentSince Sep 1, 1997 Accepting new patients
American Oncology Partners, P.a. Hematology & Oncology Past Accepting new patients

Locations

1100 Mercer Ave
Decatur, IN 46733

11143 Parkview Plaza Dr
Ste 100
Fort Wayne, IN 46845
Phone (260) 266-7400

2514 E DuPont Rd
Ste 100
Fort Wayne, IN 46825
Phone (260) 210-1491

6610 Mutual Dr
Fort Wayne, IN 46825

7910 W Jefferson Blvd
Ste 108
Fort Wayne, IN 46804
Phone (219) 484-8830

8550 Naab Rd
Ste 205
Indianapolis, IN 46260
Phone (317) 338-6040

2505 N Lebanon St
Ste 125
Lebanon, IN 46052
Phone (765) 483-7333

1025 Michigan Ave
Logansport, IN 46947
Phone (574) 753-9000

1123 N Western Ave
Marion, IN 46952
Phone (765) 651-9347

737 N Detroit St
Warsaw, IN 46580
Phone (260) 436-0259

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1073515987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749495",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749495",
            "telephone_number": "855-963-2100",
            "fax_number": "239-236-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 W JEFFERSON BLVD STE 108",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044159",
            "telephone_number": "260-484-8830",
            "fax_number": "260-483-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLIPARA",
        "first_name": "PRAVEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IN",
            "license": "01046718A",
            "primary": true
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "IN",
            "license": "01046718A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000693537",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000083727",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200148280",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3045547",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.