Jefferson Park Pediatrics P C

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

JEFFERSON PARK PEDIATRICS P C

Practice address

3919 W Jefferson Blvd Ste 1
Fort Wayne, IN 46804-6811

Phone

(260) 436-7722

Fax

(260) 459-0012

NPI assigned

Sep 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Giridhar Rao Veerula, MDNPI 1154421303

Title

Owner

Phone

(260) 436-7722

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vijay Veerula, DO

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1114595394
  Medicare reassignment Care Compare group NPD
• Vindhya Lakshmi Veerula, MD

  • Dermatology Physician
  • Indianapolis, IN
  • NPI 1104180793
  Medicare reassignment Care Compare group NPD
• Carol Burzon Galicia, PA

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1609686112
  Medicare reassignment Care Compare group
• Jany Perez Pedraza, ARNP

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1154280741
  Medicare reassignment Care Compare group
• Jessica Clifford

  • Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1326553066
  Medicare reassignment NPD
• Savannah E. Platt, NP

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1063131647
  Medicare reassignment NPD
• Giridhar Rao Veerula

  • Specialist
  • Fort Wayne, IN
  • NPI 1154421303
  NPD Authorized official
• Rebecca Marie Blume, PA-C

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1679664379
  Medicare reassignment
• Brittany Lee Schoenle, PA

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1598189979
  Medicare reassignment
• Lisa Moellering, RN, CPNP-PC

  • Pediatric Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1992166490
  NPD (past)

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1629263181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD STE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722",
            "fax_number": "260-459-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD STE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722",
            "fax_number": "260-459-0012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3919 W Jefferson Blvd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468046811",
            "country_code": "US",
            "telephone_number": "260-450-1313",
            "fax_number": "260-436-7722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JEFFERSON PARK PEDIATRICS P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "VEERULA",
        "authorized_official_first_name": "GIRIDHAR",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-436-7722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200262620",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jay Shree Ganesh Inc
• Jithmie Jayawickrema, PT
• Vimal Jayswal, MD
• Erica Marie Jefferies, FNP
• Jennifer Lyn Jefferies, RBT
• Jefferson Pediatrics, PC
• Deshonda Lashay Jefferson
• Erin Kay Jefferson, DO
• Jeffrey J. Shambaugh DMD PC
• Sarah Linn Jellison, APRN, FNP-BC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.