Individual provider Active NPI

Benjamin A Cunningham, ED. S.

  • School Psychologist
  • Fort Wayne, IN
National Provider Identifier
1306301387
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
1620132 Issued in IN
Practice address
1200 S Clinton St
Fort Wayne, IN 46802-3504
Phone
(260) 467-1110
NPI assigned
Feb 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 1620132 IN Primary

Addresses

Primary practice location

1200 S Clinton St
Fort Wayne, IN 46802-3504

Mailing address

1200 S Clinton St
Fort Wayne, IN 46802-3504
Phone (260) 467-1149

Other practice location 1

1200 South Barr St
Fort Wayne, IN 46802
Phone (260) 467-1149

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1620132INMDSchool Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Wayne Community Schools Past Accepting new patients
Fort Wayne Community Schools School PastSince Sep 21, 2025 Accepting new patients

Organizations & group practices 2

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": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1306301387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023504",
            "telephone_number": "260-467-1149",
            "fax_number": "260-467-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023504",
            "telephone_number": "260-467-1110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 South Barr St",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "46802",
            "country_code": "US",
            "telephone_number": "260-467-1149",
            "fax_number": "260-467-1188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "BENJAMIN",
        "middle_name": "A",
        "credential": "ED. S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-05",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IN",
            "license": "1620132",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 24, 2024; 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.