Fort Wayne Prosthodontics, Inc.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

Legal business name

FORT WAYNE PROSTHODONTICS, INC.

Practice address

4205 Hobson CT
Fort Wayne, IN 46815-8648

Phone

(260) 486-8778

NPI assigned

Apr 9, 2019

Organization subpart

No

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

Authorized official

Name

Kellie Jae Brower

Title

Office Manager

Phone

(260) 486-8778

Specialties & licenses 1

Addresses

Other names 1

• Ryan Zimmerman DDS INC Former legal business name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Interoperability endpoints

• Direct secure messaging: office@fortwaynepros.com

Practitioners 1

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

• Ryan Dean Zimmerman, DMD

  • Prosthodontics
  • Fort Wayne, IN
  • NPI 1467773911
  Medicare reassignment

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599696000000",
    "number": "1447713219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 HOBSON CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468158648",
            "telephone_number": "260-486-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 HOBSON CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468158648",
            "telephone_number": "260-486-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE PROSTHODONTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-09",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A",
        "authorized_official_last_name": "BROWER",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "JAE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "260-486-8778"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "OFFICE@FORTWAYNEPROS.COM",
            "affiliation": "N",
            "endpointDescription": "EMAIL ADDRESS",
            "address_1": "4205 Hobson Ct",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468158648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ryan Zimmerman DDS INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Fort Wayne Physical Medicine P C
• Fort Wayne Primary Care LLC
• Fort Wayne Psychiatry. P. C.
• Fort Wayne Radiology Associates LLC
• Fort Wayne Rheumatology
• Fort Wayne Seating & Rehab Corporation
• Fort Wayne Smiles PC

• Prosthodontics in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Prosthodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.