Credo Health Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01074259A Issued in IN

Legal business name

CREDO HEALTH GROUP, LLC

Doing business as

Credo Family Medicine

Practice address

10050 Auburn Park Dr
Fort Wayne, IN 46825-2389

Phone

(260) 432-6459

Fax

(260) 240-5284

NPI assigned

May 18, 2016

Last updated

Feb 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Andrew J. Mullally, M.D.NPI 1164860086

Title

Owner

Phone

(260) 445-5829

Specialties & licenses 1

Addresses

Other names 1

• Credo Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Andrew J Mullally, MD

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1164860086
  Medicare reassignment Care Compare group NPD Authorized official
• Julie Ann Funfrock, DO

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1144970575
  Medicare reassignment Care Compare group NPD
• Cassandralee A Herber

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1497284657
  Medicare reassignment Care Compare group NPD
• Emily Krach, DO

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1235622580
  Medicare reassignment Care Compare group NPD
• Nicholas Martin Lesch, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1992211668
  Medicare reassignment Care Compare group
• David John Moran, MD

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1679688295
  Medicare reassignment NPD

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1407203672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 AUBURN PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-432-6459",
            "fax_number": "260-240-5284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 AUBURN PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-432-6459",
            "fax_number": "260-240-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDO HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "MULLALLY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-445-5829",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01074259A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credo Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robin M Crawford, MS
• Sheri Crawford
• Tessa Creager
• Tiffane Spring Creager
• Creative Compounding Solutions LLC (Medicine Chest)
• Anna Creech, RBT
• Matthew Leroy Creech, DDS
• Abigail E. Creigh, RD
• Lucinda M Cress, RN
• Guy G Crevecoeur, MD

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; 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.