Psychiatric Services P C

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01057700A Issued in IN

Legal business name

PSYCHIATRIC SERVICES P C

Practice address

800 Broadway
Ste 208
Fort Wayne, IN 46802-2149

Phone

(260) 425-3204

Fax

(260) 425-3206

NPI assigned

Oct 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mahender Reddy Surakanti, M.DNPI 1417940909

Title

M.D.

Phone

(260) 425-3204

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

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

• Mahender Reddy Surakanti, MD

  • Psychiatry Physician
  • Fort Wayne, IN
  • NPI 1417940909
  Medicare reassignment NPD Authorized official
• Mary A Larocque, MSW LCSW

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1851309876
  Medicare reassignment

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1194913228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40139",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468040139",
            "telephone_number": "260-425-3204",
            "fax_number": "260-425-3206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BROADWAY",
            "address_2": "STE 208",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022149",
            "telephone_number": "260-425-3204",
            "fax_number": "260-425-3206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC SERVICES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "SURAKANTI",
        "authorized_official_first_name": "MAHENDER",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "260-425-3204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01057700A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Shaye Proxmire
• Robert Alan Pruett III, AGACNP-BC
• Bethany Pruitt, MSW, LCSW
• Zabrina Przybilla, MSED
• Psychiatric Innovations PC (Fawver Wellness Clinic)
• Psychological Service Associates, Inc
• Garima Pudasaini, MD
• Abigail Puff, MS, CCC, SLP
• Sue A Puff, MSW, LCSW
• Gisella P Puga, CRNA

• Psychiatry Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.