NPIMap

Individual provider Active NPI

Jeffery A Yoder, MD

  • Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1184625949
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01040292A Issued in IN
Practice address
11141 Parkview Plaza Dr Ste 305
Fort Wayne, IN 46845-1715
Phone
(260) 484-9611
Fax
(260) 484-1004
NPI assigned
Aug 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01040292A IN Primary

Addresses

Primary practice location

11141 Parkview Plaza Dr Ste 305
Fort Wayne, IN 46845-1715

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other identifiers 3

IdentifierTypeStateIssuer
103410352MedicaidMI
0998121MedicaidOH
100082270MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01040292AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Hospital, Inc. Past Accepting new patients
Associated Surgeons and Physicians, LLC Past Accepting new patients
Northeast Obstetrics & Gynecology, LLC Past Accepting new patients
Indiana Surgical Specialists, LLC Surgery Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1184625949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR STE 305",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451715",
            "telephone_number": "260-484-9611",
            "fax_number": "260-484-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YODER",
        "first_name": "JEFFERY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01040292A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103410352",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0998121",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100082270",
            "state": "IN"
        }
    ],
    "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 Jul 14, 2021; 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.