Directclinic SBC, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

DIRECTCLINIC SBC, LLC

Practice address

1355 Getz Rd Ste C
Fort Wayne, IN 46804-1609

Phone

(260) 212-1900

NPI assigned

Feb 22, 2021

Organization subpart

No

Name

Sudhakar Santhana Krishnan

Title

Ceo

Phone

(260) 750-0418

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

• Directclinic SBC, LLC

  • Primary Care Clinic/Center
  • Kendallville, IN
  • NPI 1154086841
  NPD tax ID

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

• Theodore Stephen Sauer Jr., M.D.

  • Family Medicine Physician
  • Kendallville, IN
  • NPI 1881674703
  NPD (past)

Tax ID family

Directclinic (2 organizations share this tax ID)

Locations

• DirectClinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 30, 2021.

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1336733229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 GETZ RD STE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041609",
            "telephone_number": "260-212-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 GETZ RD STE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041609",
            "telephone_number": "260-212-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIRECTCLINIC SBC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "SANTHANA KRISHNAN",
        "authorized_official_first_name": "SUDHAKAR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-750-0418"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "FORTWAYNE",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1355 Getz Rd Ste C",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468041609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "DirectClinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DirectClinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michaela Dinwiddie
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• Directclinic LLC
• Directclinic LLC
• Cynthia Dirig, RN-BSN
• Levi Edward Lynn Dirig
• Melanie Dirig
• Brett Michael Disalle, DDS
• Kristine Louise Discala, PH.D, HSPP

• All providers in Fort Wayne, IN
• Primary Care Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.