Individual provider Active NPI

Julie Ann Funfrock, DO

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1144970575
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02008137A Issued in IN
Practice address
10050 Auburn Park Dr
Fort Wayne, IN 46825-2389
Phone
(260) 432-6459
Fax
(260) 240-5284
NPI assigned
Mar 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TL.0009112 CO
Student in an Organized Health Care Education/Training Program 390200000X TL.0009112 CO
Family Medicine Physician 207Q00000X 02008137A IN Primary

Addresses

Primary practice location

10050 Auburn Park Dr
Fort Wayne, IN 46825-2389

Mailing address

10050 Auburn Park Dr
Fort Wayne, IN 46825-2389
Phone (260) 432-6459

Other names 1

  • Julie Ann Weilbaker Former name

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
I20250716000345 IN Practitioner - Family Practice 5698154813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Credo Health Group LLCGroup PAC ID 2769775782, 5 clinicians

Practice addresses (Care Compare)

10050 Auburn Park Dr
Fort Wayne, IN 46825-2389
Phone (260) 432-6459

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
  • Dupont Hospital LLC Hospital, Fort Wayne, IN, CCN 150150
  • Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Credo Health Group, LLC Family Medicine CurrentSince Jul 2, 2025 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

10050 Auburn Park Dr
Fort Wayne, IN 46825
Phone (260) 432-6459

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 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": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1144970575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 AUBURN PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-432-6459",
            "fax_number": "260-240-5284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 AUBURN PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-432-6459",
            "fax_number": "260-240-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNFROCK",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-28",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "TL.0009112",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "TL.0009112",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02008137A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "WEILBAKER",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.