NPIMap

Organization Active NPI

Indiana Surgical Specialists, LLC

  • Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1528044625
Registry record updated Jul 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
INDIANA SURGICAL SPECIALISTS, LLC
Practice address
11141 Parkview Plaza Dr Ste 305
Fort Wayne, IN 46845-1715
Phone
(260) 484-9611
Fax
(260) 484-1004
NPI assigned
Dec 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2008

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

Authorized official

Name
Richard Hively
Title
Business Manager
Phone
(260) 484-9612

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

11141 Parkview Plaza Dr Ste 305
Fort Wayne, IN 46845-1715

Mailing address

11141 Parkview Plaza Dr Ste 305
Fort Wayne, IN 46845-1715
Phone (260) 484-9611

Other identifiers 3

IdentifierTypeStateIssuer
100055660AMedicaidIN
0270371MedicaidOH
CA7015OtherINMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Locations

885 W Connexion Way
Ste 100
Columbia City, IN 46725
Phone (260) 244-0010

11141 Parkview Plaza Dr
Ste 305
Fort Wayne, IN 46845
Phone (260) 266-8900

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1528044625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR STE 305",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451715",
            "telephone_number": "260-484-9611",
            "fax_number": "260-484-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR STE 305",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451715",
            "telephone_number": "260-484-9611",
            "fax_number": "260-484-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA SURGICAL SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "HIVELY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "260-484-9612"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100055660A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0270371",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CA7015",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.