Individual provider Active NPI

Dorinda Sue Mosbrucker, NP-C

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1497136865
Registry record updated Feb 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71005500A Issued in IN
Practice address
2512 E Dupont Rd Ste 200
Fort Wayne, IN 46825
Phone
(260) 748-3650
Fax
(260) 748-3651
NPI assigned
Jun 11, 2015
Last updated
Feb 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71005500A IN Primary
Family Nurse Practitioner 363LF0000X 71005500A IN

Addresses

Primary practice location

2512 E Dupont Rd Ste 200
Fort Wayne, IN 46825

Mailing address

2512 E Dupont Rd Ste 200
Fort Wayne, IN 46825-1609
Phone (260) 748-3650

Other practice location 1

1314 E 7th St Ste 201
Auburn, IN 46706-2533
Phone (260) 748-3650

Other practice location 2

6811 Lima Rd
Fort Wayne, IN 46818-1145
Phone (260) 748-3650

Other practice location 3

2124 N Biomet Dr
Warsaw, IN 46582-7858
Phone (260) 748-3650

Other identifiers 3

IdentifierTypeStateIssuer
P02018855OtherINRAILROAD MEDICARE
1090735OtherININDIANA BCBS
201301240MedicaidIN

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150717001641 IN Practitioner - Nurse Practitioner 4880907948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71005500AINMDNurse Practitioner

Interoperability endpoints

  • Direct secure messaging: dorinda.mosbrucker@332484775247876.direct.elationemr.com

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549497600000",
    "number": "1497136865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 E DUPONT RD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251609",
            "telephone_number": "260-748-3650",
            "fax_number": "765-622-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 E DUPONT RD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46825",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1314 E 7th St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "IN",
            "postal_code": "467062533",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6811 Lima Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468181145",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2124 N Biomet Dr",
            "address_purpose": "LOCATION",
            "city": "Warsaw",
            "state": "IN",
            "postal_code": "465827858",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSBRUCKER",
        "first_name": "DORINDA",
        "middle_name": "SUE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-11",
        "last_updated": "2019-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71005500A",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71005500A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P02018855",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA BCBS",
            "identifier": "1090735",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201301240",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.