NPIMap

Individual provider Active NPI

Marlene Clare Bultemeyer, MD

  • Neurology Physician
  • Fort Wayne, IN
National Provider Identifier
1083828719
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
01066634A Issued in IN
Practice address
7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone
(260) 436-2416
Fax
(260) 436-9662
NPI assigned
May 10, 2007
Last updated
Aug 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 01066634A IN Primary

Addresses

Primary practice location

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Mailing address

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 436-2416

Other identifiers 3

IdentifierTypeStateIssuer
3034657MedicaidOH
1083828719MedicaidMI
200974740MedicaidIN

Other names 1

  • Marlene C Sarrazine Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbultemeyer@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100325000499 IN Practitioner - Neurology 2860528148 Reassigns benefits to 2 organizations
I20101207001227 OH Practitioner - Neurology 2860528148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Indiana University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allied Physicians IncGroup PAC ID 5193625846, shared by 2 NPIs, 4 clinicians
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

140 Fox Rd
Suite 209
Van Wert, OH 45891-2492
Phone (800) 686-3963

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 436-2416

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
50.34 of 100Reported as group
Quality
41.58
Promoting interoperability
0
Improvement activities
40
Cost
73.15

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Fort Wayne Physicians, LLC CurrentSince Sep 10, 2023 Accepting new patients
Iu Health Medical Group, LLC CurrentSince Oct 1, 2025 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

256 E Pettit Ave
Ste 100
Fort Wayne, IN 46806

7956 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 435-2836

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

Interoperability endpoints

  • Direct secure messaging: mbultemeyer@direct.iuhealth.org

Organizations & group practices 5

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": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1083828719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7956 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-2416",
            "fax_number": "260-436-9662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7956 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-2416",
            "fax_number": "260-436-9662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULTEMEYER",
        "first_name": "MARLENE",
        "middle_name": "CLARE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-10",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01066634A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3034657",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083828719",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200974740",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbultemeyer@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7956 W Jefferson Blvd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARLENE",
            "last_name": "SARRAZINE",
            "middle_name": "C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.