Super Shot Inc.

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

License

N/A Issued in IN

Legal business name

SUPER SHOT INC.

Practice address

1515 Hobson Rd
Fort Wayne, IN 46805-4802

Phone

(260) 424-7468

Fax

(260) 739-5623

NPI assigned

Apr 5, 2010

Organization subpart

No

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

Authorized official

Name

Connie Heflin

Title

Executive Director

Phone

(260) 424-7468

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19516/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas A Giaquinta

  • Pediatrics Physician
  • Fort Wayne, IN
  • NPI 1326281650
  NPD (past)
• Robert Ervin Wilkins, MD

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1992749485
  NPD (past)

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

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1427373372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 HOBSON RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054802",
            "telephone_number": "260-424-7468",
            "fax_number": "260-739-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HOBSON RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054802",
            "telephone_number": "260-424-7468",
            "fax_number": "260-739-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER SHOT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-05",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "HEFLIN",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "260-424-7468"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "IN",
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200977620A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glenis A Sundberg, MS. ED; LMFT
• Will Sunderland
• Curtis A Sunderlin
• Kimberly Ann Sunderlin
• Sunshine Home Assistance Services, Inc
• Superior Van & Mobility
• Supreme Hearing Company, Inc. (Miracle-Ear)
• Mahender Reddy Surakanti, MD
• Arvind Surendran, M.D.
• Surgery Center of Fort Wayne

• Public Health or Welfare Agency in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Public Health or Welfare Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.