NPIMap

Organization Active NPI

Prevail Prosthetics and Orthotics, Inc

  • Prosthetic/Orthotic Supplier
  • Fort Wayne, IN
National Provider Identifier
1366583759
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
PREVAIL PROSTHETICS AND ORTHOTICS, INC
Practice address
7735 W Jefferson Blvd
Suite C
Fort Wayne, IN 46804-4135
Phone
(260) 483-5219
Fax
(260) 484-2291
NPI assigned
Feb 9, 2007
Last updated
Nov 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

Name
Christi Hudson
Title
Business Manager
Phone
(260) 483-5219

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X NU Primary

Addresses

Primary practice location

7735 W Jefferson Blvd
Suite C
Fort Wayne, IN 46804-4135

Mailing address

7735 W Jefferson Blvd
Suite C
Fort Wayne, IN 46804-4135
Phone (260) 483-5219

Other identifiers 1

IdentifierTypeStateIssuer
200405280MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930088187 IN DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 6709903263 Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 5

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Prevail Prosthetics and Orthotics7735 W Jefferson Blvd, Fort Wayne, IN 46804-4135(260) 483-5219 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 2021

National Provider Directory

National Provider Directory
Tax ID family
Prevail Prosthetics Orthotics8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

7735 W Jefferson Blvd
Ste C
Fort Wayne, IN 46804
Phone (260) 483-5219

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1366583759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7735 W JEFFERSON BLVD",
            "address_2": "SUITE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044135",
            "telephone_number": "260-483-5219",
            "fax_number": "260-484-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7735 W JEFFERSON BLVD",
            "address_2": "SUITE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044135",
            "telephone_number": "260-483-5219",
            "fax_number": "260-484-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVAIL PROSTHETICS AND ORTHOTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "CHRISTI",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "260-483-5219"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200405280",
            "state": "IN"
        }
    ],
    "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 Nov 29, 2018; 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.