Leonard I Mastbaum, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

01041346 Issued in IN

Practice address

11123 Parkview Plaza Dr
Suite 202
Fort Wayne, IN 46845-1707

Phone

(260) 373-4280

Fax

(260) 373-4288

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Indiana Medical Associates, LLC

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1780628545
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363996800000",
    "number": "1619928249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 E DUPONT RD",
            "address_2": "SUITE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251545",
            "telephone_number": "260-373-9700",
            "fax_number": "260-373-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11123 PARKVIEW PLAZA DR",
            "address_2": "SUITE 202",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451707",
            "telephone_number": "260-373-4280",
            "fax_number": "260-373-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTBAUM",
        "first_name": "LEONARD",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2013-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IN",
            "license": "01041346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100360850",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000606758",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerome D. Massenburg, M.D.
• Kara Massey
• Deanna L. Massie, CNS
• Kathy Massonne, LCSW
• Mastbaum Endocrinology
• Marni F Mastbaum, MS ED
• Emily Mastelou-Page, NNP
• Kirk E Masten, DO
• Stacy Rose Masters, RN
• Jennifer Diane Mata

• Endocrinology, Diabetes & Metabolism Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Endocrinology, Diabetes & Metabolism Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.