Active NPI
Marc Wooten, M.D.
- Rheumatology Physician
- Fort Wayne, IN
National Provider Identifier
1619984341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- H6716
- Practice address
- 2121 Lake Ave
Department of Veterans Affairs (11)
Fort Wayne, IN 46805-5100 - Phone
- (260) 460-1311
- Fax
- (260) 421-1827
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | H6716 | TX | Primary |
Addresses
Primary practice location
2121 Lake Ave
Department of Veterans Affairs (11)
Fort Wayne, IN 46805-5100
Mailing address
2121 Lake Ave
Department of Veterans Affairs (11)
Fort Wayne, IN 46805-5100
Phone (260) 460-1311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H6716 | TX | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619984341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"address_2": "DEPARTMENT OF VETERANS AFFAIRS (11)",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "260-460-1311",
"fax_number": "260-421-1827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"address_2": "DEPARTMENT OF VETERANS AFFAIRS (11)",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "260-460-1311",
"fax_number": "260-421-1827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOTEN",
"first_name": "MARC",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "TX",
"license": "H6716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.