Vibra Hospital of Fort Wayne, LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

100121321 Issued in IN

Legal business name

VIBRA HOSPITAL OF FORT WAYNE, LLC

Doing business as

Vibra Hospital of Fort Wayne

Practice address

2200 Randallia Dr
5TH Floor
Fort Wayne, IN 46805-4638

Phone

(260) 399-2900

Fax

(260) 399-2958

NPI assigned

Jan 10, 2007

Last updated

Dec 14, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Clint T. Fegan

Title

Sec/Treas

Phone

(717) 591-5700

Specialties & licenses 1

Addresses

Other names 1

• Vibra Hospital of Fort Wayne Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174673636. Details of each certification follow.

• CCN 152027 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 152027

Legal name

VIBRA HOSPITAL OF FORT WAYNE

Certification status

Terminated Voluntary: merger or closure, Jan 31, 2019

Provider type (POS)

Hospital – Long-term

Participating since

Sep 1, 2008

Last certification

Mar 26, 2014

Beds

48

Ownership / control type

Private (for profit)

Most recent change of ownership

Oct 25, 2010 (1 total)

Facility address

2200 Randallia Drive 5TH Floor
Fort Wayne, IN 46805

Locations

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544745600000",
    "number": "1174673636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 EAST RIVER PARK PLACE E #460",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937201560",
            "telephone_number": "559-892-2500",
            "fax_number": "559-892-2442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 RANDALLIA DR",
            "address_2": "5TH FLOOR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054638",
            "telephone_number": "260-399-2900",
            "fax_number": "260-399-2958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRA HOSPITAL OF FORT WAYNE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2018-12-14",
        "status": "A",
        "authorized_official_last_name": "FEGAN",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "SEC/TREAS",
        "authorized_official_telephone_number": "717-591-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "IN",
            "license": "100121321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vibra Hospital of Fort Wayne",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vibra Hospital of Fort Wayne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Priya Verma, PHARMD, RPH
• Rajesh Verma, M.D.
• Ram Kishun Verma, M.D.
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• Michele Viers, NP

• Long Term Care Hospital in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Long Term Care Hospital in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.