NPIMap

Organization Active NPI

D L Fortson M D P C

  • Family Medicine Physician
  • Munster, IN
National Provider Identifier
1184710428
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01037803 Issued in IN
Legal business name
D L FORTSON M D P C
Doing business as
Fortson Family Care and Wellness Center
Practice address
1950 45TH Ave
Suite 100
Munster, IN 46321-3917
Phone
(219) 924-9277
Fax
(219) 924-9281
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

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

Authorized official

Name
Darryl L Fortson, M DNPI 1538255823
Title
President & Ceo
Phone
(219) 924-9277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 01037803 IN Primary

Addresses

Primary practice location

1950 45TH Ave
Suite 100
Munster, IN 46321-3917

Mailing address

1950 45TH Ave
Suite 100
Munster, IN 46321-3917
Phone (219) 924-9277

Other identifiers 1

IdentifierTypeStateIssuer
000000359839OtherINANTHEM, BC/BS PROVIDER

Other names 1

  • Fortson Family Care and Wellness Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1184710428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 45TH AVE",
            "address_2": "SUITE 100",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213917",
            "telephone_number": "219-924-9277",
            "fax_number": "219-924-9281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 45TH AVE",
            "address_2": "SUITE 100",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213917",
            "telephone_number": "219-924-9277",
            "fax_number": "219-924-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D L FORTSON M D P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "FORTSON",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "219-924-9277",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01037803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM, BC/BS PROVIDER",
            "identifier": "000000359839",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortson Family Care and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Munster, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; 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.