NPIMap

Organization Active NPI

Allied Physicians Inc

Doing business as Fort Wayne Neurosurgery

  • Neurological Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1366433369
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
ALLIED PHYSICIANS INC
Doing business as
Fort Wayne Neurosurgery
Practice address
7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone
(260) 436-2416
NPI assigned
Oct 31, 2005
Last updated
Dec 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Authorized official

Name
Isa S Canavati, MDNPI 1952308413
Title
President
Phone
(260) 436-2416

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 9

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Neurology with Special Qualifications in Child Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0402X
Vascular Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084V0102X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Mailing address

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 436-2416

Other names 1

  • Fort Wayne Neurosurgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040327000031 IN Part B Supplier - Clinic/Group Practice 5193625846 Receives reassigned benefits from 7 practitioners
6 other NPIs on this enrollment
Practice locations: Fort Wayne, IN
O20040422000314 IN Part B Supplier - Clinic/Group Practice 5193625846 Receives reassigned benefits from 10 practitioners
3 other NPIs on this enrollment
Practice locations: Fort Wayne, IN; Roanoke, IN
O20110815000039 OH Part B Supplier - Clinic/Group Practice 5193625846 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Van Wert, OH

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2520 Lake Ave
Fort Wayne, IN 46805
Phone (260) 435-7956

2622 Lake Ave
Fort Wayne, IN 46805
Phone (260) 425-3100

7411 Hope Dr
Ste C
Fort Wayne, IN 46815

7836 W Jefferson Blvd
Fort Wayne, IN 46804

7910 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (219) 436-2424

7956 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 435-2836

7956 W Jefferson Blvd
#120
Fort Wayne, IN 46804
Phone (260) 399-4702

1655 N Cass St
Wabash, IN 46992
Phone (260) 463-2133

8 John Kissinger Dr
Bldg 8
Wabash, IN 46992

274 E Chicago St
Coldwater, MI 49036
Phone (517) 279-5400

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544140800000",
    "number": "1366433369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7956 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7956 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIED PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2018-12-07",
        "status": "A",
        "authorized_official_last_name": "CANAVATI",
        "authorized_official_first_name": "ISA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-436-2416",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Wayne Neurosurgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fort Wayne Neurosurgery",
            "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 Dec 7, 2018; 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.