Syed R. Mumtaz, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

01049582A Issued in IN

Practice address

909 E State Blvd
Fort Wayne, IN 46805-3404

Phone

(260) 481-2700

Fax

(260) 481-2717

NPI assigned

Feb 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hospital Care Group PCGroup PAC ID 7416107487, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Hospital Care Group, P.C.

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1295083624
  Medicare reassignment Care Compare group NPD
• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1407848500
  Medicare reassignment NPD
• Hancock Physician Network, LLC

  • Family Medicine Physician
  • Greenfield, IN
  • NPI 1609806470

  Child & Adolescent Psychiatry

  Medicare reassignment NPD
• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1437983103
  NPD
• Family & Childrens Service of Fort Wayne Inc

  • Community/Behavioral Health Agency
  • Fort Wayne, IN
  • NPI 1699820720
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1396718573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUMTAZ",
        "first_name": "SYED",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IN",
            "license": "01049582A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200224110",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Mullins, LPN
• Lauren M Mullins, RD
• Tracy E Mullins, NP
• Derek Mumaw, DPT
• Christina Marie Mummert, O.D.
• Andrea Mundt, PHARMD
• Mungovan Chiropractic PC
• Michael Thomas Mungovan, DC
• Irfan Munir
• Muneebah Munir, M.D

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.