NPIMap

Organization Active NPI

Surgery One Anesthesia, LLC

  • Anesthesiology Physician
  • Fort Wayne, IN
National Provider Identifier
1144724402
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SURGERY ONE ANESTHESIA, LLC
Practice address
5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone
(260) 484-8551
Fax
(260) 482-5060
NPI assigned
Mar 21, 2018
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Mrs. Barbara Janice Hathaway
Title
Credentialing Officer
Phone
(260) 408-2203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

5050 N Clinton St
Fort Wayne, IN 46825-5886

Mailing address

5052 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 484-8551

Other practice location 1

11420 Parkview Circle Dr
Fort Wayne, IN 46845-1729
Phone (260) 482-5194

Other practice location 2

11130 Parkview Circle Dr
Fort Wayne, IN 46845-1735
Phone (260) 672-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180413001005 IN Part B Supplier - Clinic/Group Practice 8820351463 Receives reassigned benefits from 36 practitioners
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

11420 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (260) 482-5194

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1144724402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5052 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-484-8551",
            "fax_number": "260-408-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255886",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11420 Parkview Circle Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451729",
            "country_code": "US",
            "telephone_number": "260-482-5194",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11130 Parkview Circle Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451735",
            "country_code": "US",
            "telephone_number": "260-672-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURGERY ONE ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "HATHAWAY",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "JANICE",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "260-408-2203",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "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 27, 2025; 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.