NPIMap

Organization Active NPI

Nova Physician Group PLLC

  • Primary Care Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1528815396
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NOVA PHYSICIAN GROUP PLLC
Practice address
436 E Washington Blvd
Fort Wayne, IN 46802-3210
Phone
(260) 298-6240
Fax
(206) 474-3157
NPI assigned
May 1, 2024
Last updated
May 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Dr. Terrence Morton Jr.
Title
Sr. Medical Director
Phone
(773) 733-9730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

436 E Washington Blvd
Fort Wayne, IN 46802-3210

Mailing address

30 W Monroe St Ste 1200
Chicago, IL 60603-2420
Phone (773) 352-1515

National Provider Directory

National Provider Directory
Tax ID family
Nova Physician Group PLLC18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1528815396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W MONROE ST STE 1200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606032420",
            "telephone_number": "773-352-1515",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 E WASHINGTON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023210",
            "telephone_number": "260-298-6240",
            "fax_number": "206-474-3157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA PHYSICIAN GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "MORTON",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_title_or_position": "SR. MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "773-733-9730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 1, 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.