Individual provider Active NPI

Larry H. Lambertson

  • Psychiatry Physician
  • Fort Wayne, IN
National Provider Identifier
1124019005
Registry record updated Apr 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01040684A Issued in IN
Practice address
909 E State Blvd
Fort Wayne, IN 46805-3404
Phone
(260) 481-2700
Fax
(260) 481-2717
NPI assigned
Oct 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01040684A IN Primary

Addresses

Primary practice location

909 E State Blvd
Fort Wayne, IN 46805-3404

Mailing address

909 E State Blvd
Fort Wayne, IN 46805-3404
Phone (260) 481-2700

Other identifiers 1

IdentifierTypeStateIssuer
100351140MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091014000576 IN Practitioner - Psychiatry 1153467659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Kentucky College of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Center IncGroup PAC ID 6709795636, 24 clinicians

Practice addresses (Care Compare)

1930 Dowling St
Kendallville, IN 46755-9436
Phone (260) 347-4400

Hospital & facility affiliations

  • Parkview Noble Hospital Hospital, Kendallville, IN, CCN 150146

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Center Inc CurrentSince Dec 31, 2022 Accepting new patients
Northeastern Center, Inc CurrentSince Dec 31, 2022 Accepting new patients

Locations

1850 Wesley Rd
Auburn, IN 46706
Phone (260) 925-2453

220 S Main St
Kendallville, IN 46755
Phone (219) 347-4400

1930 Dowling St
Kendallville, IN 46755
Phone (260) 347-4400

Organizations & group practices 2

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

Hospital & facility affiliations 1

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334534400000",
    "number": "1124019005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAMBERTSON",
        "first_name": "LARRY",
        "middle_name": "H.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2012-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01040684A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100351140",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.