NPIMap

Organization Active NPI

Jefferson Pediatrics, PC

  • Family Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1134542855
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71004759A Issued in IN
Legal business name
JEFFERSON PEDIATRICS, PC
Practice address
3919 W Jefferson Blvd
Suite 1
Fort Wayne, IN 46804-6811
Phone
(260) 436-7722
NPI assigned
Jan 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

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

Authorized official

Name
Giridhar Veerula, MDNPI 1154421303
Title
Physician
Phone
(260) 436-7722

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
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 71004759A IN Primary

Addresses

Primary practice location

3919 W Jefferson Blvd
Suite 1
Fort Wayne, IN 46804-6811

Mailing address

3919 W Jefferson Blvd
Suite 1
Fort Wayne, IN 46804-6811
Phone (260) 436-7722

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1391126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391126400000",
    "number": "1134542855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD",
            "address_2": "SUITE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD",
            "address_2": "SUITE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-31",
        "last_updated": "2014-01-31",
        "status": "A",
        "authorized_official_last_name": "VEERULA",
        "authorized_official_first_name": "GIRIDHAR",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "260-436-7722",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004759A",
            "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 Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.