Northeast Indiana Urology, PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

NORTHEAST INDIANA UROLOGY, PC

Practice address

2512 E Dupont Rd
Suite 100
Fort Wayne, IN 46825-1609

Phone

(260) 436-6667

Fax

(260) 469-7437

NPI assigned

May 18, 2006

Last updated

Apr 9, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John B Brinkman, MD

Title

President

Phone

(260) 436-6667

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

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.

• Salah Antar, MD

  • Clinical Pathology/Laboratory Medicine Physician
  • Tampa, FL
  • NPI 1487604930
  NPD (past)
• Melissa S. Blount, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Orlando, FL
  • NPI 1376594788
  NPD (past)
• Valerie Jeanette Fields, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Greensboro, NC
  • NPI 1043399835
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1619920295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 E DUPONT RD",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251609",
            "telephone_number": "260-436-6667",
            "fax_number": "260-469-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 E DUPONT RD",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251609",
            "telephone_number": "260-436-6667",
            "fax_number": "260-469-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDIANA UROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "BRINKMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-436-6667",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0748972",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100081380",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northeast Indiana Genetics, LLC
• Northeast Indiana Orthodontics, LLC
• Northeast Indiana Pediatric Specialists, PC
• Northeast Indiana Urology PC
• Northeast Indiana Urology, P.C.
• Northeast Indiana Urology. P.C.
• Northeast Medical Associates, PC
• Northeast Obstetrics & Gynecology, LLC
• Northeast Obstetrics & Gynecology, LLC (Northeast OB-GYN, LLC)
• Northeast Obstetrics & Gynecology, LLC

• Urology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Urology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; 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.