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Organization Active NPI

QHG of Fort Wayne Company LLC

  • General Practice Physician
  • Fort Wayne, IN
National Provider Identifier
1619918026
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
QHG OF FORT WAYNE COMPANY LLC
Practice address
7333 W Jefferson Blvd
Fort Wayne, IN 46804-6280
Phone
(260) 458-3843
Fax
(260) 637-1601
NPI assigned
Jun 8, 2006
Last updated
Oct 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Kristina Music
Title
Director, Provider Enrollment
Phone
(615) 465-7377

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary
Physical Therapist 225100000X

Addresses

Primary practice location

7333 W Jefferson Blvd
Fort Wayne, IN 46804-6280

Mailing address

PO Box 689022
Franklin, TN 37068-9022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040429000830 IN Part B Supplier - Clinic/Group Practice 8628988367 Receives reassigned benefits from 18 practitioners
Practice locations: Bluffton, IN; Fort Wayne, IN

National Provider Directory

National Provider Directory

Member organizations 11

Organizations listed as members of this organization in the National Provider Directory.

Locations

15897 Collection Ctr Dr
Chicago, IL 60693

1980 N Main St
Bluffton, IN 46714
Phone (260) 353-1954

11635 Coldwater Rd
Fort Wayne, IN 46845
Phone (260) 637-1661

12404 Lima Crossing Dr
Ste 200
Fort Wayne, IN 46818
Phone (260) 619-5022

6920 Pointe Inverness Way
Fort Wayne, IN 46804
Phone (260) 436-4060

7333 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 435-7334

1700 Alber St
Ste 100
Wabash, IN 46992
Phone (260) 563-9410

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lutheran Hospital of IndianaFort Wayne, IN, CCN 150017 Hospital 5% Or Greater Indirect Ownership Interest (42.45%) Nov 30, 2014
Dupont Hospital LLCFort Wayne, IN, CCN 150150 Hospital 5% Or Greater Indirect Ownership Interest (99%) Jul 25, 2007
Lutheran Downtown HospitalFort Wayne, IN, CCN 150047 Hospital 5% Or Greater Indirect Ownership Interest (42.45%) Nov 30, 2014
The Orthopaedic Hospital of Lutheran Health NetworkFort Wayne, IN, CCN 150168 Hospital 5% Or Greater Direct Ownership Interest (29.99%) Dec 1, 2014

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1619918026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7333 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046280",
            "telephone_number": "260-458-3843",
            "fax_number": "260-637-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QHG OF FORT WAYNE COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "MUSIC",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7377"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.