NPIMap

Individual provider Active NPI

Smitha Patibandla, MD

  • Psychiatry Physician
  • Fort Wayne, IN
National Provider Identifier
1154580918
Registry record updated Aug 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01066011A Issued in IN
Practice address
800 Broadway
Suite 315
Fort Wayne, IN 46802-2149
Phone
(260) 489-6030
Fax
(260) 489-5536
NPI assigned
Jun 6, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01066011A IN Primary

Addresses

Primary practice location

800 Broadway
Suite 315
Fort Wayne, IN 46802-2149

Mailing address

800 Broadway
Suite 315
Fort Wayne, IN 46802-2149
Phone (260) 489-6030

Other identifiers 1

IdentifierTypeStateIssuer
200969710MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091012000465 IN Practitioner - Psychiatry 8426194069 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians
Hospital Care Group PCGroup PAC ID 7416107487, 29 clinicians
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians
Southlake Community Mental Health Center IncGroup PAC ID 5991600355, 37 clinicians

Practice addresses (Care Compare)

150 W Market St
Suite 400
Indianapolis, IN 46204-2810
Phone (855) 743-2247

3955 W Washington Ctr Rd
Fort Wayne, IN 46818-1526
Phone (260) 344-4035

8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247

8555 Taft St
Merrillville, IN 46410-6123
Phone (219) 769-4005

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
FWBH, LLC CurrentSince Jan 3, 2023 Accepting new patients
Eventus Ecs, Inc CurrentSince Nov 1, 2025 Accepting new patients
Extended Care Specialists, Inc Psychiatry CurrentSince Nov 1, 2025 Accepting new patients
Eventus Wholehealth Midwest Inc CurrentSince Nov 1, 2025 Accepting new patients
Major Hospital Past Accepting new patients
Reid Hospital & Health Care Services, Inc Past Accepting new patients
Reid Hospital & Health Care Services Inc Past Accepting new patients

Locations

2100 Midway St
Columbus, IN 47201
Phone 3178181240225

3955 W Washington Center Rd
#R
Fort Wayne, IN 46818

3955 W Washington Center Rd
Fort Wayne, IN 46818
Phone (260) 800-3601

150 W Market St
Ste 400
Indianapolis, IN 46204

8398 Mississippi St
Fl 2
Merrillville, IN 46410

Interoperability endpoints

  • Direct secure messaging: smitha.patibandla.p1@direct.geminus.nextgenshare.com

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1154580918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BROADWAY",
            "address_2": "SUITE 315",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022149",
            "telephone_number": "260-489-6030",
            "fax_number": "260-489-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BROADWAY",
            "address_2": "SUITE 315",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022149",
            "telephone_number": "260-489-6030",
            "fax_number": "260-489-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATIBANDLA",
        "first_name": "SMITHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-06",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01066011A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200969710",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.