NPIMap

Organization Active NPI

Ophthalmology Consultants of Fort Wayne PC

  • Ambulatory Surgical Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1194708792
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
05-009567-1 Issued in IN
Legal business name
OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE PC
Practice address
7232 Engle Rd
Fort Wayne, IN 46804-2222
Phone
(260) 436-7205
Fax
(260) 432-1339
NPI assigned
Nov 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Authorized official

Name
Tricia Pieper
Title
Practice Manager
Phone
(260) 436-7205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 05-009567-1 IN Primary

Addresses

Primary practice location

7232 Engle Rd
Fort Wayne, IN 46804-2222

Mailing address

7232 Engle Rd
Fort Wayne, IN 46804-2222
Phone (260) 436-7205

Other identifiers 2

IdentifierTypeStateIssuer
490003832OtherINRR MEDICARE
200177420AMedicaidIN

Other names 1

  • Surgery Center of Ophthalmology Consultants Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111118000399 IN Part B Supplier - Ambulatory Surgical Center 4789657974 Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Ophthalmology Consultants of Fort WayneCCN 15C0001074
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0935044Surgery Center of Ophthalmology Consultants7232 Engle Road, Fort Wayne, IN 46804Certificate of waiverOct 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ophthalmology Consultan5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1194708792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7232 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042222",
            "telephone_number": "260-436-7205",
            "fax_number": "260-432-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7232 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042222",
            "telephone_number": "260-436-7205",
            "fax_number": "260-432-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "PIEPER",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "260-436-7205"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "05-009567-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "490003832",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200177420A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Center of Ophthalmology Consultants",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgery Center of Ophthalmology Consultants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.