Individual provider Active NPI

Samantha Vonderau, PA

  • Physician Assistant
  • Fort Wayne, IN
National Provider Identifier
1124999321
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7201 Engle Rd
Fort Wayne, IN 46804-2228
Phone
(260) 432-1800
Fax
(260) 432-1804
NPI assigned
Sep 12, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

7201 Engle Rd
Fort Wayne, IN 46804-2228

Mailing address

7201 Engle Rd
Fort Wayne, IN 46804-2228
Phone (260) 432-1800

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251121000508 IN Practitioner - Physician Assistant 2668964255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6619 Brotherhood Way
Fort Wayne, IN 46825-4226

7201 Engle Rd
Fort Wayne, IN 46804-2228

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Medicine Consultants LLC CurrentSince Nov 12, 2025 Accepting new patients

Locations

306 E Maumee St
Ste 103
Angola, IN 46703
Phone (260) 432-1800

7201 Engle Rd
Fort Wayne, IN 46804
Phone (260) 432-1800

Interoperability endpoints

  • Direct secure messaging: samantha.vonderau.1@1725.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/1725/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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 3

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": "1757635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1124999321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042228",
            "telephone_number": "260-432-1800",
            "fax_number": "260-432-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042228",
            "telephone_number": "260-432-1800",
            "fax_number": "260-432-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VONDERAU",
        "first_name": "SAMANTHA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.