Fort Wayne Psychiatry. P. C.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

FORT WAYNE PSYCHIATRY. P. C.

Practice address

3400 E Coliseum Blvd
Ste 340
Fort Wayne, IN 46805-1644

Phone

(260) 484-1312

Fax

(260) 471-0996

NPI assigned

Oct 14, 2006

Last updated

Jan 15, 2017By 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. Prevesh Kumar Rustagi, M. D.NPI 1245237411

Title

President

Phone

(260) 484-1312

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

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.

• Prevesh K Rustagi, M.D.

  • Psychiatry Physician
  • Fort Wayne, IN
  • NPI 1245237411
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484438400000",
    "number": "1427148782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 E COLISEUM BLVD",
            "address_2": "STE 340",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051644",
            "telephone_number": "260-484-1312",
            "fax_number": "260-471-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 E COLISEUM BLVD",
            "address_2": "STE 340",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051644",
            "telephone_number": "260-484-1312",
            "fax_number": "260-471-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE PSYCHIATRY. P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-14",
        "last_updated": "2017-01-15",
        "status": "A",
        "authorized_official_last_name": "RUSTAGI",
        "authorized_official_first_name": "PREVESH",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-484-1312",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100389780A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Wayne Pediatric Dentistry LLC
• Fort Wayne Pediatrics, PC
• Fort Wayne Physical Medicine P C (Fort Wayne Physical Medicine)
• Fort Wayne Primary Care LLC
• Fort Wayne Prosthodontics, Inc.
• Fort Wayne Radiology Associates LLC (Dexa Diagnostics)
• Fort Wayne Rheumatology
• Fort Wayne Seating & Rehab Corporation
• Fort Wayne Smiles PC
• Fort Wayne Upright MRI, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2017; 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.