Individual provider Active NPI

David S. Mohan, MD

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1578876785
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01073536A Issued in IN
Practice address
3534 Brooklyn Ave
Fort Wayne, IN 46809-1361
Phone
(260) 478-5130
Fax
(260) 478-5133
NPI assigned
Jul 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01073536A IN
Family Medicine Physician 207Q00000X 01073536A IN Primary

Addresses

Primary practice location

3534 Brooklyn Ave
Fort Wayne, IN 46809-1361

Mailing address

6920 Pointe Inverness Way Ste 200
Fort Wayne, IN 46804-7934
Phone (260) 479-3516

Other identifiers 1

IdentifierTypeStateIssuer
201214460MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address david.mohan@lutheranhealthnetwork.cernerdirect.com

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140409000096 IN Practitioner - Family PracticePractitioner - Internal Medicine 6002002722 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Practice addresses (Care Compare)

235 Hauenstein Rd
Huntington, IN 46750-8803
Phone (260) 504-4110

2516 E Dupont Rd
Fort Wayne, IN 46825-1608
Phone (260) 434-6076

3534 Brooklyn Ave
Fort Wayne, IN 46809-1361
Phone (260) 432-2297

Hospital & facility affiliations

  • Caretenders Home health agency, Fort Wayne, IN, CCN 157470
  • Adoration Home Health Home health agency, Fort Wayne, IN, CCN 157583
  • Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
  • St Joseph Health System, LLC Hospital, Fort Wayne, IN, CCN 150047
  • Dupont Hospital LLC Hospital, Fort Wayne, IN, CCN 150150
  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01073536AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Medical Group LLC CurrentSince May 5, 2014 Accepting new patients
Lutheran Medical Group LLC Internal Medicine CurrentSince May 5, 2014 Accepting new patients

Locations

2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076

3534 Brooklyn Ave
Fort Wayne, IN 46809
Phone (219) 478-5180

6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514

7916 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-2298

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1578876785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3516",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3534 BROOKLYN AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468091361",
            "telephone_number": "260-478-5130",
            "fax_number": "260-478-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "DAVID",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-16",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01073536A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01073536A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201214460",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.mohan@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "3534 Brooklyn Ave",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468091361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.