Fort Wayne Primary Care LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FORT WAYNE PRIMARY CARE LLC

Practice address

7802 W Jefferson Blvd Ste a
Fort Wayne, IN 46804-4138

Phone

(260) 999-6924

Fax

(260) 222-2844

NPI assigned

May 27, 2022

Organization subpart

No

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

Authorized official

Name

Vishaal Veerula, MD

Title

Owner

Phone

(260) 999-6924

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26403/brand/1/csg/1/fhir/r4

Practitioners 4

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

• Mary Ellen Clark, CFNP

  • Family Nurse Practitioner
  • Warren, IN
  • NPI 1891031621
  Medicare reassignment NPD
• Jessica R Ramer, NP

  • Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1134553357
  Medicare reassignment NPD
• Kathleen Vanderreyden, NP

  • Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1225668312
  Medicare reassignment NPD
• Denise Irene Houck, NP

  • Adult Health Nurse Practitioner
  • Fairview, OR
  • NPI 1528338423

  IN

  Medicare reassignment NPD

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1528707619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7802 W JEFFERSON BLVD STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044138",
            "telephone_number": "260-999-6924",
            "fax_number": "260-222-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7802 W JEFFERSON BLVD STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044138",
            "telephone_number": "260-999-6924",
            "fax_number": "260-222-2844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-27",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "VEERULA",
        "authorized_official_first_name": "VISHAAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-999-6924",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fort Wayne Orthopaedics, LLC Surgicenter
• Fort Wayne Orthopedics, LLC
• Fort Wayne Pediatric Dentistry LLC
• Fort Wayne Pediatrics, PC
• Fort Wayne Physical Medicine P C
• Fort Wayne Prosthodontics, Inc.
• Fort Wayne Psychiatry. P. C.
• Fort Wayne Radiology Associates LLC
• Fort Wayne Rheumatology
• Fort Wayne Seating & Rehab Corporation

• Internal Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; 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.