Active NPI
Cynthia Gannon, MD
- Family Medicine Physician
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01042254A
- Practice address
- 436 E Washington Blvd
Fort Wayne, IN 46802-3210 - Phone
- (260) 264-7711
- NPI assigned
- Oct 4, 2006
- Last updated
- Nov 8, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01042254A | IN | Primary |
Addresses
Primary practice location
436 E Washington Blvd
Fort Wayne, IN 46802-3210
Mailing address
436 E Washington Blvd
Fort Wayne, IN 46802-3210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vohra Wound Physicians of the West, P.C. | Family Medicine | Current | Accepting new patients |
| Illinois Post-Acute Medical Services 1 PC | Current | Accepting new patients | |
| Oak Street Health Physicians Group, PC | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Locations
3601 SW 160th Ave
Ste 250
Miramar, FL 33027
Phone (305) 866-9951
9465 Counselors Row
Ste 200
Indianapolis, IN 46240
Phone (463) 220-4646
833 Park East Blvd
Lafayette, IN 47905
Phone (765) 441-3168
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Primary Care Clinic/Center
- Chicago, IL
- NPI 1083051643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731024000000",
"number": "1649366360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "436 E WASHINGTON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468023210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "436 E WASHINGTON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468023210",
"telephone_number": "260-264-7711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "CYNTHIA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2024-11-08",
"certification_date": "2024-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01042254A",
"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 Nov 8, 2024; 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.