Active NPI
Fort Wayne Orthopaedics, LLC
Doing business as Fort Wayne Orthopedics, LLC
- Durable Medical Equipment & Medical Supplies
- Auburn, IN
National Provider Identifier
1619281219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 50002482A
- Legal business name
- FORT WAYNE ORTHOPAEDICS, LLC
- Doing business as
- Fort Wayne Orthopedics, LLC
- Practice address
- 820 Smaltz Way, Ste B
Auburn, IN 46706-0609 - Phone
- (260) 436-8686
- Fax
- (260) 436-8585
- NPI assigned
- Aug 6, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jerald L. Cooper, M.D.
- Title
- Physician/President
- Phone
- (260) 436-8686
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 50002482 | IN | |
| Orthopaedic Hand Surgery Physician | 207XS0106X | 50002482 | IN | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | 50002482 | IN | |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 50002482 | IN | |
| Orthopaedic Trauma Physician | 207XX0801X | 50002482 | IN | |
| Podiatrist | 213E00000X | 50002482 | IN | |
| Foot Surgery Podiatrist | 213ES0131X | 50002482 | IN | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 50002482A | IN | Primary |
| Physician Assistant | 363A00000X | 50002482 | IN |
Addresses
Primary practice location
820 Smaltz Way, Ste B
Auburn, IN 46706-0609
Mailing address
PO Box 2526
Fort Wayne, IN 46801-2526
Phone (604) 368-6862
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300048779 | Medicaid | IN | |
| 0162610008 | Other | IN | DME PTAN |
Other names 1
- Fort Wayne Orthopedics, LLC
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1659398400000",
"number": "1619281219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2526",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468012526",
"telephone_number": "604-368-6862",
"fax_number": "260-436-8585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 SMALTZ WAY, STE B",
"city": "AUBURN",
"state": "IN",
"postal_code": "467060609",
"telephone_number": "260-436-8686",
"fax_number": "260-436-8585"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FORT WAYNE ORTHOPAEDICS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-08-06",
"last_updated": "2022-08-02",
"certification_date": "2022-08-02",
"status": "A",
"authorized_official_last_name": "COOPER",
"authorized_official_first_name": "JERALD",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
"authorized_official_telephone_number": "260-436-8686",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XS0106X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Hand Surgery",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XS0117X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XX0005X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XX0801X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Orthopaedic Trauma",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "213ES0131X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist, Foot Surgery",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "IN",
"license": "50002482A",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "IN",
"license": "50002482",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300048779",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DME PTAN",
"identifier": "0162610008",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Fort Wayne Orthopedics, LLC",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Fort Wayne Orthopedics, LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Auburn, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.