NPIMap

Organization Active NPI

Aberdeen Group LLC

  • Psychologist
  • Fort Wayne, IN
National Provider Identifier
1124302237
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
ABERDEEN GROUP LLC
Practice address
12948 Coldwater Rd Ste 101
Fort Wayne, IN 46845-8016
Phone
(260) 373-0880
Fax
(260) 373-0881
NPI assigned
Oct 7, 2011
Last updated
Mar 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Thomas Dettmer, PSY.D. HSPPNPI 1750519377
Title
Psy.D. HSPP/ Owner
Phone
(260) 373-0880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

12948 Coldwater Rd Ste 101
Fort Wayne, IN 46845-8016

Mailing address

12948 Coldwater Rd Ste 101
Fort Wayne, IN 46845-8016
Phone (260) 373-0880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120131000698 IN Part B Supplier - Clinic/Group Practice 5597922757 Receives reassigned benefits from 15 practitioners
Practice locations: Fort Wayne, IN; Warsaw, IN

National Provider Directory

National Provider Directory
Tax ID family
Aberdeen Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

12948 Coldwater Rd
Ste 101
Fort Wayne, IN 46845
Phone (260) 373-0880

3804 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-0880

3894 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-0880

115 Park Ridge Dr
Warsaw, IN 46580
Phone (260) 373-0880

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1124302237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12948 COLDWATER RD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468458016",
            "telephone_number": "260-373-0880",
            "fax_number": "260-373-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12948 COLDWATER RD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468458016",
            "telephone_number": "260-373-0880",
            "fax_number": "260-373-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABERDEEN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-07",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "DETTMER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PSY.D. HSPP/ OWNER",
        "authorized_official_telephone_number": "260-373-0880",
        "authorized_official_credential": "PSY.D. HSPP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "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 25, 2024; 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.