Fort Wayne Medical Institute

Primary specialty

SpecialistTaxonomy code 174400000X

License

01042585 Issued in IN

Legal business name

FORT WAYNE MEDICAL INSTITUTE

Practice address

4424 E State Blvd
Fort Wayne, IN 46815-6917

Phone

(260) 483-4433

Fax

(260) 483-4223

NPI assigned

Feb 14, 2008

Last updated

Dec 22, 2020By 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

Dr. Hassan Taki, MDNPI 1114911807

Title

Owner

Phone

(260) 483-4433

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

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.

• Hassan Taki, M.D.

  • Specialist
  • Fort Wayne, IN
  • NPI 1114911807
  Medicare reassignment Care Compare group Authorized official
• Mohamed Taki, M.D.

  • Allergy & Immunology Physician
  • Fort Wayne, IN
  • NPI 1447604368

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1659549475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4424 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156917",
            "telephone_number": "260-483-4433",
            "fax_number": "260-483-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156917",
            "telephone_number": "260-483-4433",
            "fax_number": "260-483-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE MEDICAL INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "TAKI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-483-4433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "01042585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0963453",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1114911807",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Wayne Hearing Center & Audiology, Inc. (Quality House Hearing Care Center)
• Fort Wayne Integrative Medicine
• Fort Wayne Medical Clinic PC
• Fort Wayne Medical Education Program (The Family Medicine Center)
• Fort Wayne Medical Education Program Inc
• Fort Wayne Medical Laboratory Corporation
• Fort Wayne Medical Oncology & Hemat (Ft Wayne Med Oncology and Hematology)
• Fort Wayne Medical Oncology and Hematology Inc
• Fort Wayne Medical Oncology and Hematology Inc
• Fort Wayne Medical Oncology and Hematology, Inc

• Specialist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.